Provider Demographics
NPI:1568787463
Name:SHARIAT, BRIDGET MARIE (DO)
Entity type:Individual
Prefix:DR
First Name:BRIDGET
Middle Name:MARIE
Last Name:SHARIAT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:311 S CLARK ST
Mailing Address - Street 2:
Mailing Address - City:CARROLL
Mailing Address - State:IA
Mailing Address - Zip Code:51401-3038
Mailing Address - Country:US
Mailing Address - Phone:712-792-3581
Mailing Address - Fax:712-792-2124
Practice Address - Street 1:405 S CLARK ST STE 100
Practice Address - Street 2:
Practice Address - City:CARROLL
Practice Address - State:IA
Practice Address - Zip Code:51401-3047
Practice Address - Country:US
Practice Address - Phone:712-792-2222
Practice Address - Fax:712-792-3875
Is Sole Proprietor?:No
Enumeration Date:2010-04-02
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA4429207Q00000X
ORDO176355207Q00000X
IADO-06577207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine