Individual
GENESIS GAYLE BRIDGES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1001 12TH AVE, #200, FORT WORTH, TX 76104-3926
(817) 850-2000
(817) 850-2015
Mailing address
PO BOX 911230, DALLAS, TX 75391-1230
(972) 997-8000
(972) 234-2987
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA09312
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
339472801
—
TX
01
—
P01701268
RAILROAD
TX
Enumeration date
08/04/2014
Last updated
12/12/2016
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