Healthcare Provider Details

I. General information

NPI: 1598381089
Provider Name (Legal Business Name): AARON J SURBAUGH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2020
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 5142
APO AP
96368-5142
US

IV. Provider business mailing address

52ND MDG UNIT 3690
APO AE
09126
US

V. Phone/Fax

Practice location:
  • Phone: 315-630-4060
  • Fax:
Mailing address:
  • Phone: 314-452-8333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number77488-21
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: