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NPI Code Detail

MEDICARE: GEORGE A AYDELOTT M.D.

MEDICARE:   GEORGE A AYDELOTT  M.D.
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
12085R0202XDiagnostic Radiology PhysicianJ0432TX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00152144OTHERTXRAILROAD-MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1841296019
Entity Type Code : Individual
Provider Name (Legal Business Name) : GEORGE A AYDELOTT M.D.
Provider Business Mailing Address
First Line : 3560 DELAWARE ST STE 209
Second Line :
City : BEAUMONT
State : TX
Zip : 77706-3059
Country : US
Telephone Number : 409-899-3682
Fax Number : 409-898-0834
Provider Business Practice Location Address
First Line : 3560 DELAWARE ST STE 209
Second Line :
City : BEAUMONT
State : TX
Zip : 77706-3059
Country : US
Telephone Number : 409-899-3682
Fax Number : 409-898-0834
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2005
Last Update Date : 06/23/2011

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Directions to “ GEORGE A AYDELOTT M.D.” Practice Location

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