Provider Demographics
NPI:1346467115
Name:SMALLEY, AARON DAVID (MD)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:DAVID
Last Name:SMALLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-1010
Mailing Address - Country:US
Mailing Address - Phone:801-379-2925
Mailing Address - Fax:801-379-2959
Practice Address - Street 1:220 N 1200 E
Practice Address - Street 2:STE 101
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-5862
Practice Address - Country:US
Practice Address - Phone:801-341-6200
Practice Address - Fax:801-766-3289
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6914436-1205207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT87-0283576Medicaid
UT87-0283576Medicaid