Individual
DR. THEODORE ALLEN BRIDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1014 S 320TH ST, SUITE C, FEDERAL WAY, WA 98003-5344
(253) 941-0673
(253) 941-8109
Mailing address
1014 S 320TH ST, SUITE C, FEDERAL WAY, WA 98003-5344
(253) 941-0673
(253) 941-8109
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD00029692
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1079177
—
WA
Enumeration date
09/13/2006
Last updated
07/08/2007
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