Provider Demographics
NPI:1295809846
Name:ALDRIDGE, KENNETH W (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:W
Last Name:ALDRIDGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:701 UNIVERSITY BLVD E
Mailing Address - Street 2:SUITE 908
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-2086
Mailing Address - Country:US
Mailing Address - Phone:205-344-9393
Mailing Address - Fax:205-759-7744
Practice Address - Street 1:701 UNIVERSITY BLVD E
Practice Address - Street 2:SUITE 908
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-2086
Practice Address - Country:US
Practice Address - Phone:205-344-9393
Practice Address - Fax:205-758-6750
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL00010811208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL103894Medicaid
AL051593010OtherBCBS OF ALABAMA
AL510I340011OtherMEDICARE
AL103894Medicaid