Provider Demographics
NPI:1336374909
Name:BRIDGE, ROBERT STUART JR (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:STUART
Last Name:BRIDGE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6360 S 3000 E
Mailing Address - Street 2:STE 220
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-6924
Mailing Address - Country:US
Mailing Address - Phone:801-944-3199
Mailing Address - Fax:801-944-3180
Practice Address - Street 1:34503 9TH AVE S
Practice Address - Street 2:STE 130
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8727
Practice Address - Country:US
Practice Address - Phone:253-835-5340
Practice Address - Fax:253-835-5350
Is Sole Proprietor?:No
Enumeration Date:2009-05-26
Last Update Date:2018-06-04
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Provider Licenses
StateLicense IDTaxonomies
390200000X
WAMD60630909207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program