Provider Demographics
NPI:1629474978
Name:ALDRICH, GARY LEE JR (PA-C)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:LEE
Last Name:ALDRICH
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:319-294-4298
Practice Address - Street 1:202 10TH ST SE STE 270
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-2420
Practice Address - Country:US
Practice Address - Phone:319-294-4319
Practice Address - Fax:319-294-4298
Is Sole Proprietor?:No
Enumeration Date:2014-11-14
Last Update Date:2025-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA134292363A00000X
NC001005368363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical