Basic Information
| Provider Information | |||||||||
| NPI: | 1417145921 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DONNA M. BRIDGE MD PA | ||||||||
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| OtherOrganizationName: | BRIDGE BREAST AND AESTHETIC SURGERY CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 608 MEDICAL CARE DR | ||||||||
| Address2: | |||||||||
| City: | BRANDON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335115937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8136842506 | ||||||||
| FaxNumber: | 8136845785 | ||||||||
| Practice Location | |||||||||
| Address1: | 608 MEDICAL CARE DR | ||||||||
| Address2: | |||||||||
| City: | BRANDON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335115937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8136842506 | ||||||||
| FaxNumber: | 8136845785 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2007 | ||||||||
| LastUpdateDate: | 10/10/2007 | ||||||||
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| AuthorizedOfficialLastName: | BRIDGE | ||||||||
| AuthorizedOfficialFirstName: | DONNA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENR | ||||||||
| AuthorizedOfficialTelephone: | 8136842506 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | ME78627 | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.