Provider Demographics
NPI:1518911106
Name:TUNGATE, AARON WOOD (PA)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:WOOD
Last Name:TUNGATE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-7208
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2410
Practice Address - Country:US
Practice Address - Phone:817-882-2420
Practice Address - Fax:817-882-2582
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04362363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX410782YKPWMedicare PIN
TX8G5520Medicare PIN
TX410782YKP5Medicare PIN
Q39224Medicare UPIN
TX8G5519Medicare PIN