Provider Demographics
NPI:1184250870
Name:BRIDGEWAY ONCOLOGY
Entity type:Organization
Organization Name:BRIDGEWAY ONCOLOGY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:STEVE
Authorized Official - Last Name:FU
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:503-481-4594
Mailing Address - Street 1:17610 SW ALEXANDER ST
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97003-4411
Mailing Address - Country:US
Mailing Address - Phone:503-481-4594
Mailing Address - Fax:503-210-1445
Practice Address - Street 1:17610 SW ALEXANDER ST
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97003-4411
Practice Address - Country:US
Practice Address - Phone:503-481-4594
Practice Address - Fax:503-210-1445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-13
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR276027Medicaid