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General NPI Number Information
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NPI Number | 1629160635
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Entity Type | Individual
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Provider Name | CHARLES E ELDRIDGE MD
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Gender | Male
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 03/15/2023
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Provider Practice Location Address
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Address Line | 614 W BYPASS
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City | ANDALUSIA
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State | AL
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Zip | 36420-4731
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Country | US
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Telephone | 334-222-3555
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Fax | 334-427-9522
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Provider Business Mailing Address
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Address Line | 614 W BYPASS
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City | ANDALUSIA
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State | AL
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Zip | 36420-4731
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Country | US
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Telephone | 334-222-3555
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Fax | 334-427-9522
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | 16342
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License Number State | AL
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