Individual
DR. ROBERT LOREN BRIDGES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1751 E. GARDNER WAY, SUITE B, WASILLA, AK 99654
(907) 357-1220
(907) 357-1222
Mailing address
P.O. BOX 751, GIRDWOOD, AK 99587
(907) 382-0952
(866) 305-3886
Taxonomy
Speciality
Code
Description
License number
State
2085N0904X
Nuclear Radiology Physician
4098
AK
2085R0202X
Diagnostic Radiology Physician
Primary
4098
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4098
STATE OF AK MEDICAL LICEN
AK
05
—
MD5606
—
AK
05
—
MDG155
—
AK
05
—
MDG1551
—
AK
05
—
MDG1552
—
AK
05
—
MDG1553
—
AK
01
—
N2018
BLUE CROSS BLUE SHIELD
AK
Enumeration date
12/08/2006
Last updated
10/21/2011
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