Provider Demographics
NPI:1043320542
Name:ALDRICH, DANIEL J (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:ALDRICH
Suffix:
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 1:3136 HORIZON RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-7807
Mailing Address - Country:US
Mailing Address - Phone:972-475-8914
Mailing Address - Fax:972-412-8601
Practice Address - Street 1:3136 HORIZON RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-7807
Practice Address - Country:US
Practice Address - Phone:972-475-8914
Practice Address - Fax:972-412-8601
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3667207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX200034652OtherMEDICARE RAILROAD
TX88251FOtherBCBS
TX0386880001OtherPALMETTO
TXA001OtherTRICARE/CHAMPUS
TX151343401Medicaid
TX88251FOtherBCBS
TX88251FMedicare PIN
TX0009BYMedicare PIN