Provider Demographics
NPI:1427148667
Name:ALDRIDGE, EDWARD FLOYD III (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:FLOYD
Last Name:ALDRIDGE
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3091 BIENVILLE BLVD.
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564
Mailing Address - Country:US
Mailing Address - Phone:228-818-5155
Mailing Address - Fax:
Practice Address - Street 1:3091 BIENVILLE BLVD.
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564
Practice Address - Country:US
Practice Address - Phone:228-818-5155
Practice Address - Fax:228-818-5159
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11483208VP0000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0123127Medicaid
MSD80604Medicare UPIN
MS0123127Medicaid