Provider Demographics
NPI:1396109385
Name:PARAGUYA, ARIS P (MD)
Entity type:Individual
Prefix:
First Name:ARIS
Middle Name:P
Last Name:PARAGUYA
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 1:1510 E WAGON WHEEL LN STE 104
Mailing Address - Street 2:
Mailing Address - City:FORT MOHAVE
Mailing Address - State:AZ
Mailing Address - Zip Code:86426-6698
Mailing Address - Country:US
Mailing Address - Phone:928-889-2273
Mailing Address - Fax:928-212-1355
Practice Address - Street 1:1510 E WAGON WHEEL LN STE 104
Practice Address - Street 2:
Practice Address - City:FORT MOHAVE
Practice Address - State:AZ
Practice Address - Zip Code:86426-6698
Practice Address - Country:US
Practice Address - Phone:928-889-2273
Practice Address - Fax:928-212-1355
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-06
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZR80777207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program