Provider Demographics
NPI:1003666470
Name:LIGON, AEDEN J
Entity Type:Individual
Prefix:
First Name:AEDEN
Middle Name:J
Last Name:LIGON
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 1:9216 CRYSTAL SPRING DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-6510
Mailing Address - Country:US
Mailing Address - Phone:765-480-9828
Mailing Address - Fax:
Practice Address - Street 1:9216 CRYSTAL SPRING DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-6510
Practice Address - Country:US
Practice Address - Phone:765-480-9828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36003793A207PS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine