Individual
DR. JACK STEPHEN ALDRIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
30011 E STATE HIGHWAY 51, COWETA, OK 74429-7681
(918) 486-2161
(918) 486-3135
Mailing address
6600 S YALE AVE, SUITE 1400, TULSA, OK 74136-3347
(918) 488-6001
(918) 488-6010
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OK2679
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100099700A
—
OK
01
—
500522075
MEDICARE GROUP PIN
OK
Enumeration date
08/18/2005
Last updated
07/31/2015
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