Provider Demographics
NPI:1306934765
Name:BRIDGES, EUGENE DREW (MD)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:DREW
Last Name:BRIDGES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:228 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-2320
Mailing Address - Country:US
Mailing Address - Phone:919-414-7579
Mailing Address - Fax:919-570-0382
Practice Address - Street 1:523 WAIT AVE
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-2727
Practice Address - Country:US
Practice Address - Phone:919-414-7579
Practice Address - Fax:919-570-0382
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC223842084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89137RVMedicaid
NCC89011Medicare UPIN