Provider Demographics
NPI:1467491803
Name:ELDRIDGE, JAMES KEVIN (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:KEVIN
Last Name:ELDRIDGE
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 1:800 5TH AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-7300
Mailing Address - Country:US
Mailing Address - Phone:817-334-1400
Mailing Address - Fax:817-334-1410
Practice Address - Street 1:800 5TH AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-7300
Practice Address - Country:US
Practice Address - Phone:817-334-1400
Practice Address - Fax:817-334-1410
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4286207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110237224OtherRAILROAD MEDICARE
TX151160201Medicaid
TX151160202Medicaid
TXH57229Medicare UPIN
TX151160202Medicaid