Provider Demographics
NPI:1376858068
Name:BRIDGES, ROBERT BARTON (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:BARTON
Last Name:BRIDGES
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 1:34 POWDER VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62223-1925
Mailing Address - Country:US
Mailing Address - Phone:618-580-3750
Mailing Address - Fax:618-397-5494
Practice Address - Street 1:34 POWDER VALLEY DR
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62223-1925
Practice Address - Country:US
Practice Address - Phone:618-580-3750
Practice Address - Fax:618-397-5494
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.0432322085R0202X
MO316682085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology