Provider Demographics
NPI:1184807208
Name:FRODSHAM, AARON EUGENE (MD)
Entity type:Individual
Prefix:DR
First Name:AARON
Middle Name:EUGENE
Last Name:FRODSHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4624 S HOLLADAY BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-7054
Mailing Address - Country:US
Mailing Address - Phone:801-810-2999
Mailing Address - Fax:801-407-0747
Practice Address - Street 1:4624 S HOLLADAY BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-7054
Practice Address - Country:US
Practice Address - Phone:801-810-2999
Practice Address - Fax:801-407-0747
Is Sole Proprietor?:No
Enumeration Date:2007-12-12
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT309974-12052085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1184807208OtherEDUCATORS MUTUAL
UT1104759OtherDMBA
UT107100028101OtherSELECTHEALTH
UTP00953836OtherRAILROAD MEDICARE
UT1184807208Medicaid
UT10000002852001OtherBCBSU
UT129993OtherPEHP
UT862620OtherSTERLING HEALTH PLANS
UT129993OtherPEHP