Individual
JANIECE RACHELLE BRIDGES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
256 STATE HIGHWAY Y, FORSYTH, MO 65653-5618
(417) 546-4200
(417) 546-4505
Mailing address
PO BOX 1240, FORSYTH, MO 65653-1240
(417) 546-4200
(417) 546-4505
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
114296
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010060982
TRICARE TRIWEST
MO
01
—
117248
BLUE CROSS BLUE SHIELD
MO
05
—
205721103
—
MO
Enumeration date
03/15/2007
Last updated
10/25/2010
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