Provider Demographics
NPI:1760475891
Name:BRIDGES, VICTOR G (PAC)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:G
Last Name:BRIDGES
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:939 EMERALD AVE
Mailing Address - Street 2:SUITE 905
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-4502
Mailing Address - Country:US
Mailing Address - Phone:865-647-3350
Mailing Address - Fax:865-647-3359
Practice Address - Street 1:939 EMERALD AVE
Practice Address - Street 2:SUITE 905
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-4502
Practice Address - Country:US
Practice Address - Phone:865-647-3350
Practice Address - Fax:865-647-3359
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN014363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R95971Medicare UPIN
TN37143273Medicare PIN