Provider Demographics
NPI:1376757062
Name:ALDRETE, JORGE ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:ANTONIO
Last Name:ALDRETE
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 1:2213 STERLINGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243-1756
Mailing Address - Country:US
Mailing Address - Phone:205-968-0068
Mailing Address - Fax:
Practice Address - Street 1:777 MAIN ST
Practice Address - Street 2:BLDG. G
Practice Address - City:CHIPLEY
Practice Address - State:FL
Practice Address - Zip Code:32428-1580
Practice Address - Country:US
Practice Address - Phone:800-978-0068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 15595207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine