MEDICARE: JOSEPH A ALDRICH JR. DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	E2419	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396732202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH A ALDRICH JR. DO

Provider Business Mailing Address
First Line	:	PO BOX 516
Second Line	:
City	:	SILOAM SPRINGS
State	:	AR
Zip	:	72761-0516
Country	:	US
Telephone Number	:	479-549-4228
Fax Number	:	479-549-3711

Provider Business Practice Location Address
First Line	:	1101 N PROGRESS AVE # 2
Second Line	:
City	:	SILOAM SPRINGS
State	:	AR
Zip	:	72761-4343
Country	:	US
Telephone Number	:	479-549-4228
Fax Number	:	479-549-3711

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	02/13/2015

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