Most Relevant Information
Provider Data
| NPI Number: | 1003257411 |
| Provider Name: | DERRICK BRIDGES ATC,LAT |
| Entity Type: | Individual |
| Taxonomy Code: | 2255A2300X |
| Specialty: | Specialist/Technologist |
| License Number: | 2272 |
Most Important Dates
| Enumeration Date: | 07/13/2013 |
| Last Updated: | 07/13/2013 |
Provider Practice Location
11200 GOVERNOR MANLY WAY
RALEIGH
NC
276148599
Practice Location Phone/Fax
| Phone: | 9195629410 |
| Fax: |
Provider Mailing Location
11200 GOVERNOR MANLY WAY
RALEIGH
NC
276148599
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |