MEDICARE: COURTNEY SPRAGUE ALDRIDGE PA-C

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	363AM0700X	Medical Physician Assistant	03615	TX

General Provider Information

NPI Number	:	1205966819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY SPRAGUE ALDRIDGE PA-C

Provider Business Mailing Address
First Line	:	PO BOX 2317
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78298-2317
Country	:	US
Telephone Number	:	210-558-6234
Fax Number	:	210-615-1840

Provider Business Practice Location Address
First Line	:	9238 FLOYD CURL DR
Second Line	:	STE 101
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-1690
Country	:	US
Telephone Number	:	210-558-6234
Fax Number	:	210-615-1840

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

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	08/16/2011

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