Healthcare Provider Details

I. General information

NPI: 1124064530
Provider Name (Legal Business Name): EDWARD P AGUILAR P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 12/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E.MAIN ST
DANVILLE IN
46122
US

IV. Provider business mailing address

PO BOX 485
DANVILLE IN
46122-0485
US

V. Phone/Fax

Practice location:
  • Phone: 317-745-3450
  • Fax:
Mailing address:
  • Phone: 317-745-6139
  • Fax: 317-745-7873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10000357A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: