Provider Demographics
NPI:1326152307
Name:ALDRIDGE, BEVERLY S (MD)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:S
Last Name:ALDRIDGE
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:PO BOX 99371
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0371
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-7347
Practice Address - Street 1:801 7TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2733
Practice Address - Country:US
Practice Address - Phone:682-885-3199
Practice Address - Fax:382-885-7499
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9129208000000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX107324100OtherFIRSTCARE PIN
TX1099696OtherUHC PIN
TX118009306Medicaid
TX137345810OtherCSHCN GRP TPI
TX00U87ZOtherMEDICARE GROUP PIN
TX413436OtherPHCS PIN
TX140442852OtherMEDICAID GRP TPI
1750369203OtherGRP NPI NUMBER
TX10028685OtherAMERIGROUP PIN
TX4357321OtherAETNA PIN
TX5576468OtherCIGNA PIN
TX00U87ZOtherBCBSTX GRP PIN
TX124024OtherSUPERIOR PIN
TX118009307OtherCSHCN
TX82V079OtherBCBSTX IND PIN
TX1099696OtherUHC PIN
TX8L20073Medicare PIN