Individual
RYAN KYLE ALDRICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3204 MEDICAL PARK DR, SHAWNEE, OK 74804-5014
(405) 878-6800
(405) 878-6831
Mailing address
3204 MEDICAL PARK DR, SHAWNEE, OK 74804-5014
(405) 878-6800
(405) 878-6831
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
24496
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200100900A
—
OK
01
—
OK400647
RAILROAD RETIREMENT TRUST (RR MEDICARE)
—
Enumeration date
11/15/2006
Last updated
03/25/2010
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