Provider Demographics
NPI:1407840184
Name:AARANSON, R RANDAL (DPM)
Entity Type:Individual
Prefix:
First Name:R
Middle Name:RANDAL
Last Name:AARANSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 OLD DES PERES RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-1873
Mailing Address - Country:US
Mailing Address - Phone:314-569-0612
Mailing Address - Fax:314-966-0664
Practice Address - Street 1:1050 OLD DES PERES RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-1873
Practice Address - Country:US
Practice Address - Phone:314-569-0612
Practice Address - Fax:314-966-0664
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000640213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000000580882OtherANTHEM
MO1029917OtherUNITED HEALTHCARE
MO5779579OtherAETNA
MO1190602OtherCIGNA
MO148903OtherHEALTHLINK
MO5779579OtherAETNA
MO000000580882OtherANTHEM
MO4208030001Medicare NSC