Healthcare Provider Details

I. General information

NPI: 1790839694
Provider Name (Legal Business Name): JOSEPH R ARAGON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 SANDOVAL RD SW
LOS LUNAS NM
87031-7320
US

IV. Provider business mailing address

PO BOX 26028
ALBUQUERQUE NM
87125-6028
US

V. Phone/Fax

Practice location:
  • Phone: 505-865-3373
  • Fax: 505-865-2078
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number81147
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: