Provider Demographics
NPI:1407944796
Name:BRIDGEWATER, JOEL L (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:L
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 1:1110 E 6TH ST STE D
Mailing Address - Street 2:
Mailing Address - City:MUSCLE SHOALS
Mailing Address - State:AL
Mailing Address - Zip Code:35661-3957
Mailing Address - Country:US
Mailing Address - Phone:256-397-8842
Mailing Address - Fax:
Practice Address - Street 1:1110 E 6TH ST STE D
Practice Address - Street 2:
Practice Address - City:MUSCLE SHOALS
Practice Address - State:AL
Practice Address - Zip Code:35661-3957
Practice Address - Country:US
Practice Address - Phone:256-397-8842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL27993207L00000X
ALMD.32800207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL102I935745OtherMEDICARE
MSP01309083Medicaid
AL156039Medicaid