Provider Demographics
NPI:1699744359
Name:TEWES, BRIDGET A (MD)
Entity type:Individual
Prefix:DR
First Name:BRIDGET
Middle Name:A
Last Name:TEWES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 35380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5380
Mailing Address - Country:US
Mailing Address - Phone:719-866-6568
Mailing Address - Fax:719-538-2999
Practice Address - Street 1:2610 TENDERFOOT HILL ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906
Practice Address - Country:US
Practice Address - Phone:719-538-5727
Practice Address - Fax:719-226-8629
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0042421208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO56426216Medicaid
CO528430Medicare PIN
COI03367Medicare UPIN