Healthcare Provider Details

I. General information

NPI: 1831159805
Provider Name (Legal Business Name): AARON JAY MAST MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 12/18/2020
Certification Date: 12/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

583 S CLARIZZ BLVD
BLOOMINGTON IN
47401-5515
US

IV. Provider business mailing address

583 S CLARIZZ BLVD
BLOOMINGTON IN
47401-5515
US

V. Phone/Fax

Practice location:
  • Phone: 812-333-2663
  • Fax: 812-333-8140
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number01059319A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number01059319A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: