Provider Demographics
NPI:1497724017
Name:ALDRIDGE, ANDREW J (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
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 31210
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86003-1210
Mailing Address - Country:US
Mailing Address - Phone:928-773-2222
Mailing Address - Fax:928-773-2598
Practice Address - Street 1:77 W FOREST AVE STE 201
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1483
Practice Address - Country:US
Practice Address - Phone:928-773-2222
Practice Address - Fax:928-773-2598
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30031208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1497724017OtherUHC
AZ1497724017OtherAZFMC
AZ1497724017OtherCIGNA
AZ1497724017OtherBCBS
AZ1497724017OtherHUMANA
AZ694332Medicaid
AZ1497724017OtherAETNA