Healthcare Provider Details

I. General information

NPI: 1174557839
Provider Name (Legal Business Name): ARTURO AGUILLON-BOUCHE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 12/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 HALL RD
STURBRIDGE MA
01566-1519
US

IV. Provider business mailing address

69 HALL RD
STURBRIDGE MA
01566-1519
US

V. Phone/Fax

Practice location:
  • Phone: 508-347-9444
  • Fax: 508-347-9004
Mailing address:
  • Phone: 508-347-9444
  • Fax: 508-347-9004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number77374
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: