JERRY ALAN BRIDGHAM (NPI# 1740361336) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740361336 |
| Entity Type | Individual |
| Full Name | JERRY ALAN BRIDGHAM |
| Credential | MD |
| Practice Address |
14810 Old Saint Augustine Rd Ste 106 Credentialing Department Jacksonville FL 32258-2558 |
| Mailing Address |
Po Box 44004 Jacksonville FL 32231-4004 |
| Practice Telephone | 9042687701 |
| Practice Fax Number | 9042689708 |
| Mailing Telephone | 9042021032 |
| Mailing Fax Number | 9042689708 |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2015-11-19 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080A0000X |
Pediatrics Specialization: Adolescent Medicine |
ME49397 | FL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 3747107-00 | 05 |
| Street Address |
14810 OLD SAINT AUGUSTINE RD STE 106 CREDENTIALING DEPARTMENT |
| City | JACKSONVILLE |
| State | FL |
| Zip Code | 32258-2558 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629079405 | Kevin Allen Kasych | Pediatrics | 14810 Old Saint Augustine Rd Ste 106, Credentialing Department, Jacksonville, FL 32258-2558 | 2005-08-03 |
| 1487987491 | Andrea Ellen Clark Shah | Pediatrics | 14810 Old Saint Augustine Rd Ste 106, Jacksonville, FL 32258-2558 | 2009-09-09 |
| 1629159223 | Virginia Gibson Black | Pediatrics | 14810 Old Saint Augustine Rd Ste 106, Credentialing Department, Jacksonville, FL 32258-2558 | 2006-10-18 |
| 1992746283 | Gary Glen Soud | Pediatrics | 14810 Old Saint Augustine Rd Ste 106, Credentialing Department, Jacksonville, FL 32258-2558 | 2006-06-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437794237 | Nicoleta Descalzo | Behavior Technician | 12724 Grand Bay Parkway West, Suite 410, Jacksonville, FL 32258 | 2019-11-15 |
| 1992275572 | William Lundgren | Nurse Anesthetist, Certified Registered | 3625 University Blvd South, Jacksonville, FL 32258 | 2018-11-27 |
| 1104301159 | Emergency Physicians Inc | Emergency Medicine | 14534 Old St Augustine Rd, Suite 3110, Jacksonville, FL 32258 | 2018-09-26 |
| 1679092886 | Palm Life Medical Associates Pa | Assisted Living Facility | 12494 Acosta Oaks Drive, Jacksonville, FL 32258 | 2017-09-19 |
| 1679013932 | Optometry Vision Care Pllc | Optometrist | 14866 Old St. Augustine Rd Unit 110, Jacksonville, FL 32258 | 2017-03-06 |
| 1467991950 | North Florida Vision Group Inc | Optometrist | 14866 Old St. Augustine Rd., Suite 110, Jacksonville, FL 32258 | 2017-02-16 |
| 1124576566 | Revolution Chiropractic LLC | Chiropractor | 14866 Old St Augustine Road, Suite 113, Jacksonville, FL 32258 | 2016-09-14 |
| 1396291936 | Robyn Reaves | Nurse Practitioner | 12361 Richards Glen Ct, Jacksonville, FL 32258 | 2016-09-01 |
| 1326595927 | Lauren Cost | Chiropractor | 14866 Old St. Augustine Road, Suite 113, Jacksonville, FL 32258 | 2016-09-01 |
| 1487991170 | Mark Steven Colosimo | Pharmacist | 13820 Old St Augustine Road, Jacksonville, FL 32258 | 2013-01-15 |
| Find all providers in zip 32258 | ||||
| Taxonomy Code | 2080A0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Adolescent Medicine |
| A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033768981 | North Florida Pediatrics, Pa | Pediatrics | 4501 Atlantic Boulevard, Jacksonville, FL 32207 | 2019-09-04 |
| 1841794682 | W.b. Stewart Tigers Athletics Boosters | Pediatrics | 1658 Kings Rd, Jacksonville, FL 32209-6167 | 2018-03-19 |
| 1487755567 | Charles Richardson Martin | Pediatrics | 2 Dewitt St, Jacksonville, NC 28540-5649 | 2006-09-25 |
| 1336252444 | Charles B. Mcintosh | Pediatrics | 3160 Edgewood Ave W, Jacksonville, FL 32209-2245 | 2006-08-16 |
| 1922091156 | Anne T Egan | Pediatrics | 2121 Park St, Jacksonville, FL 32204-3811 | 2005-08-23 |
| 1326046350 | Iris Eisenberg | Pediatrics | 11521 N Main St, Jacksonville, FL 32218-4002 | 2005-07-13 |
| 1568856698 | Afton Turner | Pediatrics | 4788 Hodges Blvd Ste B108, Jacksonville, FL 32224-7222 | 2015-03-26 |
| 1316385164 | Rainbow Pediatric Center | Pediatrics | 4788 Hodges Blvd, Suite B-108, Jacksonville, FL 32224-7222 | 2013-06-13 |
| 1043456148 | Rachna A Krish | Pediatrics | 13241 Bartram Park Blvd, Suite # 209, Jacksonville, FL 32258-5212 | 2008-12-20 |
| 1043346745 | Jacksonville Pediatrics | Pediatrics | 2606 Park St, Jacksonville, FL 32204-4520 | 2007-02-26 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 32258 |
Please comment or provide details below to improve the information on JERRY ALAN BRIDGHAM.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.