Healthcare Provider Details

I. General information

NPI: 1396732202
Provider Name (Legal Business Name): JOSEPH A ALDRICH JR. DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 02/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 N PROGRESS AVE # 2
SILOAM SPRINGS AR
72761-4343
US

IV. Provider business mailing address

PO BOX 516
SILOAM SPRINGS AR
72761-0516
US

V. Phone/Fax

Practice location:
  • Phone: 479-549-4228
  • Fax: 479-549-3711
Mailing address:
  • Phone: 479-549-4228
  • Fax: 479-549-3711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE2419
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: