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Gary Dean Bridges

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NPI Number Detailed Information

Provider Information:

Name: Gary Dean Bridges
Gender: M
Provider License Number If Given: A05924

NPI Information:

NPI: 1851394050
Entity Type
(Individual or Organization):
1-ind
Enumeration Date: 5/23/2005

Last Update Date: 5/18/2020

Provider Business Mailing Address:

Address: 1103 BUCKEYE AVE STE 102
Ames, IA 50010
Phone Number: 5152332225
Fax Number: 5152333774

Provider Business Practice Location Address:

Address: 1103 BUCKEYE AVE STE 102
Ames, IA 50010
Phone Number: 5152332225
Fax Number: 5152333774

Provider Taxonomy:

Primary: 111N00000X
Secondary (if any): 171100000X
State: IA

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