Provider Demographics
NPI:1861221517
Name:ALRIDGE, MARION BRANDON
Entity type:Individual
Prefix:
First Name:MARION
Middle Name:BRANDON
Last Name:ALRIDGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 AVERY SPRINGS LN
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-7483
Mailing Address - Country:US
Mailing Address - Phone:832-315-2262
Mailing Address - Fax:
Practice Address - Street 1:107 AVERY SPRINGS LN
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-7483
Practice Address - Country:US
Practice Address - Phone:832-315-2262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13008896343800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)