Provider Demographics
NPI:1720011315
Name:MAYBERRY, AARON J (MD, FACS)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:J
Last Name:MAYBERRY
Suffix:
Gender:M
Credentials:MD, FACS
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Mailing Address - Street 1:PO BOX 36420
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87176-6420
Mailing Address - Country:US
Mailing Address - Phone:505-888-3844
Mailing Address - Fax:505-503-8275
Practice Address - Street 1:7115 PROSPECT PL NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4313
Practice Address - Country:US
Practice Address - Phone:505-888-3844
Practice Address - Fax:505-503-8275
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM200171208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM9553053Medicaid
G21346Medicare UPIN