Provider Demographics
NPI:1356355036
Name:BRIDGES, RONZEE MCINTYRE (MD)
Entity type:Individual
Prefix:DR
First Name:RONZEE
Middle Name:MCINTYRE
Last Name:BRIDGES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4300 YOUREE DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-3329
Mailing Address - Country:US
Mailing Address - Phone:318-219-8555
Mailing Address - Fax:318-219-8557
Practice Address - Street 1:4300 YOUREE DR
Practice Address - Street 2:SUITE 300
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-3329
Practice Address - Country:US
Practice Address - Phone:318-219-8555
Practice Address - Fax:318-219-8557
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA017536208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAB64339Medicare UPIN
LA53056Medicare ID - Type Unspecified