Provider Demographics
NPI:1881689479
Name:AMOS, AARON M (MD)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:M
Last Name:AMOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:309 REGENCY PKWY
Mailing Address - Street 2:SUITE 107
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5165
Mailing Address - Country:US
Mailing Address - Phone:817-784-8268
Mailing Address - Fax:817-477-8881
Practice Address - Street 1:309 REGENCY PKWY
Practice Address - Street 2:SUITE 107
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-5165
Practice Address - Country:US
Practice Address - Phone:817-784-8268
Practice Address - Fax:817-477-8881
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL4854208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB156209Medicaid
TXTXB159187Medicaid
TXTXB159188Medicaid
TX153753201Medicaid
TX153753204OtherMEDICAID OTHER
TX8K7011Medicare PIN
TX153753202Medicaid
TX153753203Medicaid
TX8A0024Medicare PIN