Provider Demographics
NPI:1265060552
Name:MOULTON, AARON
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:MOULTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 OVERBY CIR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-1556
Mailing Address - Country:US
Mailing Address - Phone:501-607-4855
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES
Practice Address - Street 2:4301 WEST MARKHAM STREET, SLOT 584
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205
Practice Address - Country:US
Practice Address - Phone:501-686-6993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2023-02076207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine