Basic Information
Provider Information | |||||||||
NPI: | 1245670926 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LOPEZ | ||||||||
FirstName: | BRIDGET | ||||||||
MiddleName: | C. | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | COUGHLIN | ||||||||
OtherFirstName: | BRIDGET | ||||||||
OtherMiddleName: | ANNE | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D. | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | P.O. BOX 551420 | ||||||||
Address2: |   | ||||||||
City: | FORT LAUDERDALE | ||||||||
State: | FL | ||||||||
PostalCode: | 333551420 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8002433839 | ||||||||
FaxNumber: | 8558514405 | ||||||||
Practice Location | |||||||||
Address1: | 3001 W DR MARTIN LUTHER KING JR BLVD | ||||||||
Address2: | AMERICAN ANESTHESIOLOGY ASSOCIATES OF FLORIDA, | ||||||||
City: | TAMPA | ||||||||
State: | FL | ||||||||
PostalCode: | 336076307 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8133507244 | ||||||||
FaxNumber: | 8133507246 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/26/2013 | ||||||||
LastUpdateDate: | 12/29/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 126063018 | IL | N |   | Allopathic & Osteopathic Physicians | Anesthesiology |   | 207L00000X | ME134040 | FL | Y |   | Allopathic & Osteopathic Physicians | Anesthesiology |   |
No ID Information.