Healthcare Provider Details

I. General information

NPI: 1720011315
Provider Name (Legal Business Name): AARON J MAYBERRY MD, FACS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 05/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7115 PROSPECT PL NE
ALBUQUERQUE NM
87110-4313
US

IV. Provider business mailing address

PO BOX 36420
ALBUQUERQUE NM
87176-6420
US

V. Phone/Fax

Practice location:
  • Phone: 505-888-3844
  • Fax: 505-503-8275
Mailing address:
  • Phone: 505-888-3844
  • Fax: 505-503-8275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number200171
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: