=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154704344
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RANDY AARANSON DPM LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2015
-----------------------------------------------------
Last Update Date | 07/07/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2917 HIGHWAY K SUITE G
-----------------------------------------------------
City | O FALLON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63368-7979
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-240-1127
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1334 BENTLEY PLACE DR
-----------------------------------------------------
City | CHESTERFIELD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63005-4491
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-537-7846
-----------------------------------------------------
Fax | 314-698-2498
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. R RANDAL AARANSON
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 314-537-7846
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | MO000640
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------