Theodore Allen Bridge, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MD00029692 Issued in WA

Practice address

1014 S 320TH St
Suite C
Federal Way, WA 98003-5344

Phone

(253) 941-0673

Fax

(253) 941-8109

NPI assigned

Sep 13, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• St Francis Community Hospital

  • General Acute Care Hospital
  • Federal Way, WA
  • NPI 1093713091
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1649375114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1014 S 320TH ST",
            "address_2": "SUITE C",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980035344",
            "telephone_number": "253-941-0673",
            "fax_number": "253-941-8109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1014 S 320TH ST",
            "address_2": "SUITE C",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980035344",
            "telephone_number": "253-941-0673",
            "fax_number": "253-941-8109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRIDGE",
        "first_name": "THEODORE",
        "middle_name": "ALLEN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "MD00029692",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1079177",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brent Chin OD Inc PS
• Elliot Spencer Breshears, MD
• Bret Jacobson DDS PS
• Stephanie Lynne Brickner, MS LMFT
• Robert Stuart Bridge Jr., M.D.
• Bridgeport Family Pharmacy
• Erica Bridges
• Bridging Care, LLC
• Brighton Rehabilitation LLC
• Bristol Hospice, L.L.C.

• Pediatrics Physician in Federal Way, WA
• Providers in Federal Way, WA by specialty
• Pediatrics Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.