Basic Information
| Provider Information | |||||||||
| NPI: | 1700882990 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRIDGE | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19636 N 27TH AVE STE 206 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850274015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6027880088 | ||||||||
| FaxNumber: | 6029314544 | ||||||||
| Practice Location | |||||||||
| Address1: | 19636 N 27TH AVE STE 206 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6027880088 | ||||||||
| FaxNumber: | 6029314544 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2005 | ||||||||
| LastUpdateDate: | 12/06/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 18610 | AZ | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 27-327815 | 01 | AZ | ARIZONA MINIMALLY INVASIVE SINUS INSTITUTE PLLC | OTHER | 1376985549 | 01 | AZ | ARIZONA MINIMALLY INVASIVE SINUS INSTITUTE PLLC | OTHER |