=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194827535
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOSEPH R ARAGON MD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/05/2006
-----------------------------------------------------
Last Update Date | 07/21/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 127 SANDOVAL
-----------------------------------------------------
City | LOS LUNAS
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-865-3373
-----------------------------------------------------
Fax | 505-865-2078
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 127 SANDOVAL
-----------------------------------------------------
City | LOS LUNAS
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-865-3373
-----------------------------------------------------
Fax | 505-865-2078
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER PHYSICIAN
-----------------------------------------------------
Name | DR. JOSEPH R ARAGON SR.
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 505-865-3373
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 81147 NM
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------