Provider Information for 1265984793
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DESIREE BRIDGES
Sex: Female
NPI: 1265984793
Last Updated: 2018-11-27
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1265984793 | ||||||||||||||||
| Enumeration Date | 2016-11-01 | ||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||
| Sole Proprietor | NO | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Mailing Address | 3625 YOUREE DR SHREVEPORT, LA 71105-2121 United States Phone: 318-742-3408 | Fax: | ||||||||||||||||
| Primary Practice Address | 1301 YOUREE DR SHREVEPORT, LA 71101 United States Phone: 318-675-0804 | Fax:318-425-9030 | ||||||||||||||||
| Secondary Practice Address(es) | 1301 YOUREE DR 3018 OLD MINDEN RD STE 1117 | ||||||||||||||||
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