Provider Demographics
NPI:1497287833
Name:BRIDGES, ALEXIS GABRIELLE (DO)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:GABRIELLE
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:190 E BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6241
Mailing Address - Country:US
Mailing Address - Phone:208-381-8752
Mailing Address - Fax:
Practice Address - Street 1:333 N 1ST ST STE 150
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-6135
Practice Address - Country:US
Practice Address - Phone:208-381-3088
Practice Address - Fax:208-381-4314
Is Sole Proprietor?:No
Enumeration Date:2017-04-03
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10964152-1204207V00000X
ORDO204323207V00000X
IDO-2023207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology