Basic Information
| Provider Information | |||||||||
| NPI: | 1689823932 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALDERFER | ||||||||
| FirstName: | JEREMY | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 W 5TH ST | ||||||||
| Address2: | APT 634 | ||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282021668 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7049155674 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3119 WOODMAN DR | ||||||||
| Address2: | |||||||||
| City: | ALTOONA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 547202668 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9204964700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2008 | ||||||||
| LastUpdateDate: | 09/14/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 1234567 | NC | N | Allopathic & Osteopathic Physicians | Otolaryngology | 207Y00000X | 36777 | SC | N | Allopathic & Osteopathic Physicians | Otolaryngology | 207Y00000X | 61285 | WI | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.