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General NPI Number Information
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NPI Number | 1629474978
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Entity Type | Individual
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Provider Name | GARY LEE ALDRICH JR. PA-C
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Gender | Male
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Dates
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Enumeration Date | 11/14/2014
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Last Update Date | 12/15/2025
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Provider Practice Location Address
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Address Line | 202 10TH ST SE STE 270
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City | CEDAR RAPIDS
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State | IA
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Zip | 52403-2420
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Country | US
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Telephone | 319-294-4319
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Fax | 319-294-4298
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Provider Business Mailing Address
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Address Line | 801 YORK ST
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City | MANITOWOC
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State | WI
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Zip | 54220-4630
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Country | US
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Telephone | 920-663-9008
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Fax | 319-294-4298
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 134292
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 001005368
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License Number State | NC
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