Provider Demographics
NPI:1083845036
Name:ALDRET, STEPHANIE N (DO)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:N
Last Name:ALDRET
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18444 N 25TH AVE
Mailing Address - Street 2:310
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-1261
Mailing Address - Country:US
Mailing Address - Phone:623-474-3696
Mailing Address - Fax:623-544-5531
Practice Address - Street 1:3521 HIGHWAY 190
Practice Address - Street 2:SUITE C
Practice Address - City:EUNICE
Practice Address - State:LA
Practice Address - Zip Code:70535-5135
Practice Address - Country:US
Practice Address - Phone:337-235-8007
Practice Address - Fax:855-270-5479
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA102202830207Q00000X
OK4734207Q00000X
WV2548207Q00000X
LADO.000291207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine