Provider Demographics
NPI:1174840649
Name:ALDRIDGE, BEAU ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:BEAU
Middle Name:ANTHONY
Last Name:ALDRIDGE
Suffix:
Gender:M
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:PO BOX 732892
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-2149
Mailing Address - Country:US
Mailing Address - Phone:513-426-2194
Mailing Address - Fax:
Practice Address - Street 1:125 BAPTIST WAY STE 5C
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2274
Practice Address - Country:US
Practice Address - Phone:448-227-6820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME125139208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery