Healthcare Provider Details

I. General information

NPI: 1376503391
Provider Name (Legal Business Name): DEMETRIO JUAN AGUILA III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2122 N 117TH AVE
OMAHA NE
68164-3670
US

IV. Provider business mailing address

PO BOX 7
BOYS TOWN NE
68010-0007
US

V. Phone/Fax

Practice location:
  • Phone: 402-370-9515
  • Fax: 402-227-8245
Mailing address:
  • Phone: 402-370-9515
  • Fax: 402-227-8245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number27722
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number75023
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number27722
License Number StateNE
# 4
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number27722
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: