Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 356719 | OH |
NPI | 1487639134 |
---|---|
Provider Name | Dr. Matthew Anthony Bridger |
First Address | Columbus, OH 43220-3953 |
Second Address | Columbus, OH 43215-4683 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0698133 | (05) | OH |
A-83061 | (02) | OH |