Provider Demographics
NPI:1073675492
Name:BRIDGES, MATTHEW DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:DAVID
Last Name:BRIDGES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1855 TANNER WAY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:HARRIMAN
Mailing Address - State:TN
Mailing Address - Zip Code:37748-8302
Mailing Address - Country:US
Mailing Address - Phone:865-882-2442
Mailing Address - Fax:865-882-0251
Practice Address - Street 1:744 MIDDLE CREEK RD STE 210
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-5036
Practice Address - Country:US
Practice Address - Phone:865-446-9550
Practice Address - Fax:865-446-9551
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD 36251208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ032983Medicaid
TNH23180Medicare UPIN
TN68-0512588OtherTAX ID NUMBER