1568498442 NPI number — DR. BRIDGET KAYE FIECHTNER M.D.

Table of content: DR. BRIDGET KAYE FIECHTNER M.D. (NPI 1568498442)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568498442 NPI number — DR. BRIDGET KAYE FIECHTNER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FIECHTNER
Provider First Name:
BRIDGET
Provider Middle Name:
KAYE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568498442
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22239 MADISON PARK
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78258-2511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-481-9497
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2200 BERGQUIST DRIVE, SUITE 1 MMIM
Provider Second Line Business Practice Location Address:
WILFORD HALL MEDICAL CENTER
Provider Business Practice Location Address City Name:
LACKLAND AIR FORCE BASE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-292-5336
Provider Business Practice Location Address Fax Number:
210-292-7868
Provider Enumeration Date:
06/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  01056259A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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