Provider Demographics
NPI:1770780108
Name:MCLEMORE, AARON DAVID (MD)
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:DAVID
Last Name:MCLEMORE
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:PO BOX 13030
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71315-3030
Mailing Address - Country:US
Mailing Address - Phone:318-445-9331
Mailing Address - Fax:318-619-6899
Practice Address - Street 1:176 VERSAILLES BLVD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-2493
Practice Address - Country:US
Practice Address - Phone:318-445-9331
Practice Address - Fax:318-619-6899
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116019663390200000X
LAMD.203639207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2198033Medicaid