Provider Demographics
NPI:1548424534
Name:ARAGON, MODESTO (MD)
Entity Type:Individual
Prefix:
First Name:MODESTO
Middle Name:
Last Name:ARAGON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 E JOHN CARPENTER FWY
Mailing Address - Street 2:SUITE 850
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-2727
Mailing Address - Country:US
Mailing Address - Phone:972-957-3000
Mailing Address - Fax:972-957-3005
Practice Address - Street 1:5334 ROSS AVE
Practice Address - Street 2:SUITE 900
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-7453
Practice Address - Country:US
Practice Address - Phone:214-884-1584
Practice Address - Fax:214-884-1590
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-18
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG7391208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty