Provider Demographics
NPI:1447447552
Name:BURSHEARS, BRIDGET J (MD)
Entity type:Individual
Prefix:DR
First Name:BRIDGET
Middle Name:J
Last Name:BURSHEARS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:571 S FLOYD ST
Mailing Address - Street 2:SUITE 342
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-3818
Mailing Address - Country:US
Mailing Address - Phone:270-417-5419
Mailing Address - Fax:
Practice Address - Street 1:571 S FLOYD ST
Practice Address - Street 2:SUITE 342
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3818
Practice Address - Country:US
Practice Address - Phone:270-417-5419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6348795-1205208000000X
KY445562080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics