Provider Demographics
NPI:1407940265
Name:BRIDGES, TOMMY L (MD)
Entity Type:Individual
Prefix:
First Name:TOMMY
Middle Name:L
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 1:317 SAINT FRANCIS DR
Mailing Address - Street 2:SUITE 360
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-3965
Mailing Address - Country:US
Mailing Address - Phone:864-232-8118
Mailing Address - Fax:
Practice Address - Street 1:317 SAINT FRANCIS DR
Practice Address - Street 2:SUITE 360
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-3965
Practice Address - Country:US
Practice Address - Phone:864-232-8118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7332208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCB92225Medicare UPIN
SC8157Medicare ID - Type Unspecified