Individual
DR. JOHN PAUL BRIDE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
109 BEE ST, RALPH H JOHNSON VA MEDICAL CENTER, CHARLESTON, SC 29401-5703
(843) 789-6012
(843) 789-6623
Mailing address
109 BEE ST, CHARLESTON, SC 29401-5703
(843) 789-6012
(843) 789-6623
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
11046
NH
207R00000X
Internal Medicine Physician
Primary
31365
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
313654
—
SC
01
—
P00727204
RAILROAD MEDICARE ID-RSFPP
SC
Enumeration date
03/08/2006
Last updated
11/20/2013
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