Provider Demographics
NPI:1922197136
Name:BRIDGERS, STEPHEN BURNEY (MD)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:BURNEY
Last Name:BRIDGERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5221 PARAMOUNT PKWY STE 220
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-5490
Mailing Address - Country:US
Mailing Address - Phone:984-215-4110
Mailing Address - Fax:
Practice Address - Street 1:9858 N. W.R. LATHAN STREET
Practice Address - Street 2:
Practice Address - City:CLARKTON
Practice Address - State:NC
Practice Address - Zip Code:28433-0095
Practice Address - Country:US
Practice Address - Phone:910-647-1503
Practice Address - Fax:910-647-1505
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30542207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8918334Medicaid
NC18334OtherBCBSNC
NC204124NMedicare PIN