Healthcare Provider Details

I. General information

NPI: 1164489050
Provider Name (Legal Business Name): AARON C BORNSTEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 12/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2352 QUARTER HORSE TRAIL
OVERGAARD AZ
85933
US

IV. Provider business mailing address

2200 E SHOW LOW LAKE RD
SHOW LOW AZ
85901
US

V. Phone/Fax

Practice location:
  • Phone: 928-535-3616
  • Fax: 928-535-3615
Mailing address:
  • Phone: 928-537-6978
  • Fax: 928-537-4205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number14650
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: