Organization
REVIVAL ORTHOPAEDICS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK BRIDGES M.D. (PHYSICIAN)
(305) 694-9400
Entity
Organization
Contact information
Practice address
1190 NW 95TH ST, SUITE 305, MIAMI, FL 33150-2063
(305) 694-9400
(305) 693-6942
Mailing address
1190 NW 95TH ST, SUITE 305, MIAMI, FL 33150-2063
(305) 694-9400
(305) 693-6942
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
ME91496
FL
207X00000X
Orthopaedic Surgery Physician
ME93941
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
271502300
—
FL
05
—
274429500
—
FL
Enumeration date
06/06/2007
Last updated
12/18/2008
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