Provider Demographics
NPI:1629474978
Name:ALDRICH, GARY LEE JR (PA-C)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:LEE
Last Name:ALDRICH
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:103A MCALPINE LN
Mailing Address - Street 2:
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28352-4637
Mailing Address - Country:US
Mailing Address - Phone:910-277-7546
Mailing Address - Fax:910-277-0048
Practice Address - Street 1:103A MCALPINE LN
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-4637
Practice Address - Country:US
Practice Address - Phone:910-277-7546
Practice Address - Fax:910-277-0048
Is Sole Proprietor?:No
Enumeration Date:2014-11-14
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC001005368363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical