Provider Demographics
NPI:1770343154
Name:BRYDGES, HILLIARD TYLER THOMAS (MD)
Entity type:Individual
Prefix:
First Name:HILLIARD
Middle Name:TYLER THOMAS
Last Name:BRYDGES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:TYLER
Other - Middle Name:HILLIARD THOMAS
Other - Last Name:BRYDGES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:325 9TH AVENUE
Mailing Address - Street 2:BOX 359796
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2642
Mailing Address - Country:US
Mailing Address - Phone:206-744-2868
Mailing Address - Fax:
Practice Address - Street 1:325 9TH AVENUE
Practice Address - Street 2:BOX 359796
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104
Practice Address - Country:US
Practice Address - Phone:206-744-2868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-21
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WAMDRE.ML.61544990208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program