Provider Demographics
NPI:1710965439
Name:BRIDEN, GARY MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:MICHAEL
Last Name:BRIDEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9388 STEEPLEBUSH DR
Mailing Address - Street 2:
Mailing Address - City:BELVIDERE
Mailing Address - State:IL
Mailing Address - Zip Code:61008-7120
Mailing Address - Country:US
Mailing Address - Phone:815-332-1785
Mailing Address - Fax:
Practice Address - Street 1:4423 MANCHESTER DR
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61109-1655
Practice Address - Country:US
Practice Address - Phone:815-394-1391
Practice Address - Fax:815-226-0114
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-068930207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL834340OtherMEDICARE GROUP #
IL834340003Medicare PIN
ILD15419Medicare UPIN