Provider Demographics
NPI:1750381786
Name:BRIDGES, LLOYD (MD)
Entity type:Individual
Prefix:DR
First Name:LLOYD
Middle Name:
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 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-384-9920
Mailing Address - Fax:704-384-9925
Practice Address - Street 1:4105 MATTHEWS MINT HILL RD
Practice Address - Street 2:
Practice Address - City:MINT HILL
Practice Address - State:NC
Practice Address - Zip Code:28105-3633
Practice Address - Country:US
Practice Address - Phone:704-384-9920
Practice Address - Fax:704-384-9925
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9601246207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8918348Medicaid
NC2023349Medicare PIN
NC8918348Medicaid
NC2231084AMedicare PIN