Healthcare Provider Details

I. General information

NPI: 1619954427
Provider Name (Legal Business Name): FRANCISCO AGUIRRE CASANOVA JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: FRANCISCO AGUIRRE CASANOVA JR. M.D.

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 12/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 E IOWA ST
HOLBROOK AZ
86025-2748
US

IV. Provider business mailing address

PO BOX 729
HOLBROOK AZ
86025-0729
US

V. Phone/Fax

Practice location:
  • Phone: 928-524-2881
  • Fax: 928-524-2122
Mailing address:
  • Phone: 928-524-2881
  • Fax: 928-524-2122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number15081
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: