Individual
MR. KENNETH G BRIDGES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8513 S FEDERAL HWY, PORT ST LUCIE, FL 34952-3346
(772) 461-7500
Mailing address
9639 FAIRWOOD CT, PORT SAINT LUCIE, FL 34986-3250
(772) 489-0500
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
ME69634
FL
261QP2300X
Primary Care Clinic/Center
Primary
ME69634
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
262035900
—
FL
01
—
P00738042
RAILROAD MEDICARE
FL
Enumeration date
09/13/2005
Last updated
07/27/2026
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