Provider Demographics
NPI:1528017860
Name:ARAGON, RICO AMANCIO (MD)
Entity Type:Individual
Prefix:DR
First Name:RICO
Middle Name:AMANCIO
Last Name:ARAGON
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:PO BOX 25039
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29616-0039
Mailing Address - Country:US
Mailing Address - Phone:864-241-5199
Mailing Address - Fax:864-241-5198
Practice Address - Street 1:75 E MCBEE AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-2737
Practice Address - Country:US
Practice Address - Phone:864-241-5199
Practice Address - Fax:864-241-5198
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22894207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G357326089OtherMEDICARE ID
SCQ00846Medicaid
SC1528017860OtherNPI
SC22894OtherSTATE LICENSE
SCG35732Medicare UPIN