Provider Demographics
NPI:1003176934
Name:SECREST, AARON MICHAEL (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:MICHAEL
Last Name:SECREST
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 NORTH 1900 EAST, 4A330
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84132
Mailing Address - Country:US
Mailing Address - Phone:801-581-6465
Mailing Address - Fax:
Practice Address - Street 1:165 N UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-2990
Practice Address - Country:US
Practice Address - Phone:801-581-6465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8790910-1205207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology