Provider Demographics
NPI:1619081379
Name:AARONS, DAVID R (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:AARONS
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 1:1121 W VINE ST
Mailing Address - Street 2:SUITE 14
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-5137
Mailing Address - Country:US
Mailing Address - Phone:209-334-3153
Mailing Address - Fax:
Practice Address - Street 1:1121 WEST VINE ST
Practice Address - Street 2:STE 14
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240
Practice Address - Country:US
Practice Address - Phone:209-334-3153
Practice Address - Fax:209-334-6029
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37817207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G378170OtherCOMMERICAL INSURANCE
CA110099702OtherRAILROAD MEDICARE
CA00G378170Medicaid
CA00G378170OtherCOMMERICAL INSURANCE
$$$$$$$$$OtherSSN
CA00G378170OtherCOMMERICAL INSURANCE