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General NPI Number Information
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NPI Number | 1366132474
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Entity Type | Individual
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Provider Name | MARTIN AGUILAR PA-C
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Gender | Male
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Dates
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Enumeration Date | 05/11/2023
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Last Update Date | 12/21/2024
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Provider Practice Location Address
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Address Line | 11960 LIONESS WAY STE 260
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City | PARKER
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State | CO
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Zip | 80134-5640
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Country | US
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Telephone | 303-344-9090
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Fax |
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Provider Business Mailing Address
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Address Line | 11960 LIONESS WAY STE 260
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City | PARKER
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State | CO
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Zip | 80134-5640
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Country | US
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Telephone | 303-344-9090
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA.0008945
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License Number State | CO
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