Bridge, Theodore Allen

Bridge, Theodore Allen is an sole proprietor health care provider with primary practice located at 1014 S 320Th St Suite C, Federal Way WA 98003-5344. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. Bridge, Theodore Allen can be contacted via phone (253) 941-0673.

Contact Information

Primary practice address
1014 S 320Th St Suite C Federal Way WA 98003-5344
Fax: (253) 941-8109
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X MD00029692 Washington

Profile Details

NPI number 1649375114
LBN Legal business name Bridge, Theodore Allen
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Sep 13th, 2006
Last updated Jul 8th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1649375114 NPPES
Washington MEDICAID 1079177

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