Jerry Alan Bridgham, MD

Primary specialty

Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X

License

ME49397 Issued in FL

Practice address

14810 Old Saint Augustine Rd Ste 106
Credentialing Department
Jacksonville, FL 32258-2558

Phone

(904) 268-7701

Fax

(904) 268-9708

NPI assigned

Oct 18, 2006

Sex

Male

Sole proprietor

No

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.

• Baptist Primary Care Inc

  • Pediatrics Physician
  • Jacksonville, FL
  • NPI 1356677819
  NPD (past)
• Baptist Primary Care Inc

  • Family Medicine Physician
  • Jacksonville, FL
  • NPI 1508817529
  NPD (past)

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447891200000",
    "number": "1740361336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 44004",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322314004",
            "telephone_number": "904-202-1032",
            "fax_number": "904-268-9708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14810 OLD SAINT AUGUSTINE RD STE 106",
            "address_2": "CREDENTIALING DEPARTMENT",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322582558",
            "telephone_number": "904-268-7701",
            "fax_number": "904-268-9708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRIDGHAM",
        "first_name": "JERRY",
        "middle_name": "ALAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-18",
        "last_updated": "2015-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "FL",
            "license": "ME49397",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3747107-00",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bridge to Resolution Counseling and Rehabilitation
• Ronda Katrice Bridgeman
• Bridges Behavioral Services Inc
• Andrea Bridges
• Dana Bridges, LMHC
• Brielle Diagnostics LLC
• John M Briere-Saltis, BCABA
• Jairo Brieva, M.D.
• Brigantti Anesthesia & Spine Care
• Reuben Earl Brigety, M.D.

• Pediatric Adolescent Medicine Physician in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Pediatric Adolescent Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2015; 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.