Provider Demographics
NPI:1528105400
Name:ALDRICH, BETTY JANE (MD)
Entity type:Individual
Prefix:DR
First Name:BETTY
Middle Name:JANE
Last Name:ALDRICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 755580
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99775-5580
Mailing Address - Country:US
Mailing Address - Phone:907-474-7043
Mailing Address - Fax:907-474-5777
Practice Address - Street 1:612 N. CHANDALAR DR.
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99775-5580
Practice Address - Country:US
Practice Address - Phone:907-474-7043
Practice Address - Fax:907-474-5777
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4140207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD0494Medicaid
AKMD0494Medicaid