Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | E2480 | TX |
NPI | 1174536817 |
---|---|
Provider Name | Dr. Robert Bridges |
First Address | Austin, TX 78756-4010 |
Second Address | Austin, TX 78756-4010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2006 |
Last Update Date | 16/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
824100 | BCBS ID NUMBER (01) | TX |
C13756 | (02) | TX |