Provider Demographics
NPI:1740242460
Name:AEGIS MEDICAL CARE OF AZ, PC
Entity Type:Organization
Organization Name:AEGIS MEDICAL CARE OF AZ, PC
Other - Org Name:DEL LAGO FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:BOOR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:623-266-4699
Mailing Address - Street 1:20470 N LAKE PLEASANT RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-9708
Mailing Address - Country:US
Mailing Address - Phone:623-266-4699
Mailing Address - Fax:623-825-5630
Practice Address - Street 1:20470 N LAKE PLEASANT RD
Practice Address - Street 2:SUITE 110
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-9708
Practice Address - Country:US
Practice Address - Phone:623-266-4699
Practice Address - Fax:623-825-5630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
74767Medicare ID - Type Unspecified