Provider Demographics
NPI:1689730749
Name:ALLDREDGE, JOHN WHALEY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WHALEY
Last Name:ALLDREDGE
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 1:225 BENDEL RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2903
Mailing Address - Country:US
Mailing Address - Phone:337-232-2330
Mailing Address - Fax:337-232-1310
Practice Address - Street 1:225 BENDEL RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2903
Practice Address - Country:US
Practice Address - Phone:337-232-2330
Practice Address - Fax:337-232-1310
Is Sole Proprietor?:No
Enumeration Date:2006-12-30
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC131339207Y00000X
LAMD.026028207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1054488Medicaid
4N064F652Medicare PIN