Provider Demographics
NPI:1386683944
Name:BRIDGER, DEWEY HERBERT III (MD)
Entity type:Individual
Prefix:
First Name:DEWEY
Middle Name:HERBERT
Last Name:BRIDGER
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 936857
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-6857
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1960 S 16TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-6676
Practice Address - Country:US
Practice Address - Phone:910-343-9991
Practice Address - Fax:910-341-5164
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39162207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8918265Medicaid
NC1386683944Medicaid
NC1022110001Medicare NSC
E21368Medicare UPIN
NC080084956Medicare PIN
NC2149840Medicare PIN
NC8918265Medicaid