Provider Demographics
NPI:1083969810
Name:AGUON, JARED
Entity Type:Individual
Prefix:MR
First Name:JARED
Middle Name:
Last Name:AGUON
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:PSC BOX 20125
Mailing Address - Street 2:GROUP AID STATION, FRENCH CREEK CLINIC FC 308
Mailing Address - City:CAMP LEJUENE
Mailing Address - State:NC
Mailing Address - Zip Code:28542
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:HOLCOLM BLVD, FRENCH CREEK, BLDG 308, CLR 27, 2D MLG
Practice Address - Street 2:PSC BOX 20125
Practice Address - City:CAMP LEJUENE
Practice Address - State:NC
Practice Address - Zip Code:28542
Practice Address - Country:US
Practice Address - Phone:910-451-5125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAGUONJK183N31710I1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman