Provider Demographics
NPI:1629023437
Name:BRIDGES, WALTER STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:STEVEN
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 1:901 E CHEVES ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506-2716
Mailing Address - Country:US
Mailing Address - Phone:843-667-6229
Mailing Address - Fax:843-667-1758
Practice Address - Street 1:901 E CHEVES ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2716
Practice Address - Country:US
Practice Address - Phone:843-667-6229
Practice Address - Fax:843-667-1758
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC168002080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCH-78072Medicare UPIN