Provider Demographics
NPI:1619042975
Name:ALDRICH, GARY ELBERT (LMT)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:ELBERT
Last Name:ALDRICH
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 W BAY DR
Mailing Address - Street 2:SUITE 115
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-4900
Mailing Address - Country:US
Mailing Address - Phone:727-584-4279
Mailing Address - Fax:
Practice Address - Street 1:2401 W BAY DR
Practice Address - Street 2:SUITE 115
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-4900
Practice Address - Country:US
Practice Address - Phone:727-584-4279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA0007576171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor