Individual
DR. BRUCE MICHAEL BRIDEWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10201 ARCOS AVE, STE 201, ESTERO, FL 33928-9459
(239) 992-7822
(239) 947-5687
Mailing address
PO BOX 1209, ESTERO, FL 33929-1209
(239) 992-7822
(239) 947-5687
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME51156
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19146-1
FAA
FL
05
—
263210100
—
FL
01
—
K2012
MEDICARE GROUP
FL
Enumeration date
02/10/2006
Last updated
07/18/2016
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