Provider Demographics
NPI: | 1760430276 |
---|---|
Name: | BRIDGES, JAMES PATRICK (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | JAMES |
Middle Name: | PATRICK |
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: | PO BOX 650859 |
Mailing Address - Street 2: | DEPT 710 |
Mailing Address - City: | DALLAS |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 75265-3164 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 409-747-6240 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2785 GULF FWY S STE 165 |
Practice Address - Street 2: | |
Practice Address - City: | LEAGUE CITY |
Practice Address - State: | TX |
Practice Address - Zip Code: | 77573-4990 |
Practice Address - Country: | US |
Practice Address - Phone: | 832-505-0139 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-05-05 |
Last Update Date: | 2022-11-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | K0425 | 207Q00000X, 208M00000X, 207R00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | |
No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TX | 8B6923 | Medicare PIN | |
G38414 | Medicare UPIN |