Healthcare Provider Details

I. General information

NPI: 1134216864
Provider Name (Legal Business Name): BRUCE STUART ALDRED M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 SAVANNAH RD
LEWES DE
19958-1462
US

IV. Provider business mailing address

120 NEW RD
LEWES DE
19958-9573
US

V. Phone/Fax

Practice location:
  • Phone: 302-645-3580
  • Fax: 302-644-1475
Mailing address:
  • Phone: 302-644-1893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberC10005661
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: