Provider Demographics
NPI:1710968201
Name:EARLY, BRIDGET P (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIDGET
Middle Name:P
Last Name:EARLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 E BROADWAY STE 108
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-6082
Mailing Address - Country:US
Mailing Address - Phone:573-657-7330
Mailing Address - Fax:573-657-1772
Practice Address - Street 1:2100 E BROADWAY STE 108
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6082
Practice Address - Country:US
Practice Address - Phone:573-657-7330
Practice Address - Fax:573-657-1772
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO104142207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208289629Medicaid
MO507374205Medicaid
MO507374205Medicaid
MO000014728Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
MO208289629Medicaid