Provider Demographics
NPI:1700882990
Name:BRIDGE, ROBERT S (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:S
Last Name:BRIDGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:19636 N 27TH AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4015
Mailing Address - Country:US
Mailing Address - Phone:602-788-0088
Mailing Address - Fax:602-931-4544
Practice Address - Street 1:19636 N 27TH AVE STE 206
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027
Practice Address - Country:US
Practice Address - Phone:602-788-0088
Practice Address - Fax:602-931-4544
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ18610174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ27-327815OtherARIZONA MINIMALLY INVASIVE SINUS INSTITUTE PLLC
AZ1376985549OtherARIZONA MINIMALLY INVASIVE SINUS INSTITUTE PLLC