Individual
JERRY ALAN BRIDGHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
14810 OLD SAINT AUGUSTINE RD STE 106, CREDENTIALING DEPARTMENT, JACKSONVILLE, FL 32258-2558
(904) 268-7701
(904) 268-9708
Mailing address
PO BOX 44004, JACKSONVILLE, FL 32231-4004
(904) 202-1032
(904) 268-9708
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
ME49397
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3747107-00
—
FL
Enumeration date
10/18/2006
Last updated
11/19/2015
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