Provider Demographics
NPI:1356397699
Name:AYLESWORTH, ROBERT JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOHN
Last Name:AYLESWORTH
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 1:550 E TIMBER DR
Mailing Address - Street 2:
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-2894
Mailing Address - Country:US
Mailing Address - Phone:715-226-9232
Mailing Address - Fax:498-627-6469
Practice Address - Street 1:550 E TIMBER DR
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-2894
Practice Address - Country:US
Practice Address - Phone:715-369-4500
Practice Address - Fax:715-369-4832
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI24652-20207N00000X
WI24652-02207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30463700Medicaid
WIB51292Medicare UPIN
WI30463700Medicaid