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Individual

GARRY J. BRYDGES

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MSN, ACNP, CRNA

Contact information

Practice address
1515 HOLCOMBE BLVD, HOUSTON, TX 77030-4009
(713) 792-6161
Mailing address
PO BOX 4439, HOUSTON, TX 77210-4439
(713) 792-2991

Taxonomy

Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
610463
TX
367500000X
Certified Registered Nurse Anesthetist
Primary
610463
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
202824302
TX
01
430080271
RR MEDICARE
TX
01
83149U
BCBS
TX
Enumeration date
10/11/2006
Last updated
09/28/2011
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