Provider Demographics
NPI:1700146099
Name:AGUILAR, JOHN REXIS (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:REXIS
Last Name:AGUILAR
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 1:58 DOGLEG RD
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:VA
Mailing Address - Zip Code:22963-2312
Mailing Address - Country:US
Mailing Address - Phone:703-863-6971
Mailing Address - Fax:
Practice Address - Street 1:58 DOGLEG RD
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:VA
Practice Address - Zip Code:22963-2312
Practice Address - Country:US
Practice Address - Phone:703-863-6971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 51390207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine