Provider Demographics
NPI:1285727578
Name:BRIDGES, DONALD MORRIS (CRNA)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:MORRIS
Last Name:BRIDGES
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2344 S 1000
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47138-7163
Mailing Address - Country:US
Mailing Address - Phone:812-866-4520
Mailing Address - Fax:
Practice Address - Street 1:2344 S 1000
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:IN
Practice Address - Zip Code:47138-7163
Practice Address - Country:US
Practice Address - Phone:812-866-4520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1053520367500000X
IN28089297A367500000X
PARN602136367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000321909OtherANTHEM-SIA
PA1022545410001Medicaid
IN200179250Medicaid
IN200179250Medicaid
IN000000321909OtherANTHEM-SIA
PA1022545410001Medicaid