Individual
DR. GARY BRIDGWATER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5898 NASHWAY RD, NISSWA, MN 56468-2358
(608) 334-4812
Mailing address
5898 NASHWAY RD, NISSWA, MN 56468-2358
(608) 334-4812
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
56147
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19957
MEDICAL LICENSE
WI
01
—
56147
MINNESOTA MEDICAL LICENSE
MN
Enumeration date
05/17/2006
Last updated
03/07/2023
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