Provider Demographics
NPI:1336561067
Name:ALDRIDGE, JAMES LADD (DMTIDC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:LADD
Last Name:ALDRIDGE
Suffix:
Gender:M
Credentials:DMTIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 HORNET AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:JBPHH
Mailing Address - State:HI
Mailing Address - Zip Code:96860-3530
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:455 HORNET AVE STE 101
Practice Address - Street 2:
Practice Address - City:JBPHH
Practice Address - State:HI
Practice Address - Zip Code:96860-3530
Practice Address - Country:US
Practice Address - Phone:918-306-0365
Practice Address - Fax:808-541-2958
Is Sole Proprietor?:No
Enumeration Date:2014-01-15
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman