Provider Demographics
NPI:1790839694
Name:ARAGON, JOSEPH R (MD)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:R
Last Name:ARAGON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:127 SANDOVAL RD SW
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-7320
Mailing Address - Country:US
Mailing Address - Phone:505-865-3373
Mailing Address - Fax:505-865-2078
Practice Address - Street 1:127 SANDOVAL RD SW
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-7320
Practice Address - Country:US
Practice Address - Phone:505-865-3373
Practice Address - Fax:505-865-2078
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM81147207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM003814Medicaid
NMNMA101405OtherMEDICARE PTAN
NMNMA101405OtherMEDICARE PTAN