Provider Demographics
NPI:1376503391
Name:AGUILA, DEMETRIO JUAN III (MD)
Entity Type:Individual
Prefix:DR
First Name:DEMETRIO
Middle Name:JUAN
Last Name:AGUILA
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 460910
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-0910
Mailing Address - Country:US
Mailing Address - Phone:402-370-9515
Mailing Address - Fax:402-227-8245
Practice Address - Street 1:701 PINNACLE DR STE 107
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-6228
Practice Address - Country:US
Practice Address - Phone:402-370-9515
Practice Address - Fax:402-227-8245
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE27722207Y00000X, 208200000X, 208VP0014X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE099588074OtherMEDICARE
NE100264195-00Medicaid
NE100264197-00Medicaid
MD89792601 / KR10MEOtherBCBS MARYLAND
MD1497790398OtherGROUP NPI - CLINTON ENT
MD1851473722OtherGROUP NPI - MEDICAL & SURGICAL CLINICS OF SOUTHERN MARYLAND