Healthcare Provider Details

I. General information

NPI: 1326485897
Provider Name (Legal Business Name): AARON BORNSTEIN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2013
Last Update Date: 10/20/2020
Certification Date: 10/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 BOWLES AVE STE 300
FENTON MO
63026-2387
US

IV. Provider business mailing address

PO BOX 955534
SAINT LOUIS MO
63195-2002
US

V. Phone/Fax

Practice location:
  • Phone: 636-496-5060
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberOS16028
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2020011590
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: