Provider Demographics
NPI:1861507857
Name:AFFLECK, AARON JON (MD)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:JON
Last Name:AFFLECK
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 1:2900 VALENCIA DR
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7594
Mailing Address - Country:US
Mailing Address - Phone:208-523-6868
Mailing Address - Fax:208-523-7272
Practice Address - Street 1:2900 VALENCIA DR
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7594
Practice Address - Country:US
Practice Address - Phone:208-523-6868
Practice Address - Fax:208-523-7272
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM8206207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002797900Medicaid
ID000010032972OtherREGENCE BLUE SHIELD
IDJ4431OtherBLUE CROSS
H40444Medicare UPIN
ID11008621Medicare PIN
1100862Medicare ID - Type UnspecifiedINDIVIDUAL