Provider Demographics
NPI:1326143017
Name:BRIDGEWATER, RICHARD LEON (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LEON
Last Name:BRIDGEWATER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3071 NW 70TH TERRACE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33147-6740
Mailing Address - Country:US
Mailing Address - Phone:954-671-0111
Mailing Address - Fax:954-671-0070
Practice Address - Street 1:1951 SW 172ND AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33029-5593
Practice Address - Country:US
Practice Address - Phone:954-636-8888
Practice Address - Fax:954-671-0070
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63506174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist