MEDICARE: DR. AARON J MAYBERRY MD, FACS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician	200171	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720011315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AARON J MAYBERRY MD, FACS

Provider Business Mailing Address
First Line	:	PO BOX 36420
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87176-6420
Country	:	US
Telephone Number	:	505-888-3844
Fax Number	:	505-503-8275

Provider Business Practice Location Address
First Line	:	7115 PROSPECT PL NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-4313
Country	:	US
Telephone Number	:	505-888-3844
Fax Number	:	505-503-8275

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	05/10/2012

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