Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | G63954 | CA |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | G63954 | CA |
NPI | 1154352011 |
---|---|
Provider Name | Mr. Duane E Bridges |
First Address | Hawthorne, CA 90250-2321 |
Second Address | Hawthorne, CA 90250-2321 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 24/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G639541 | (05) | CA |
F11237 | (02) | CA |