MEDICARE: MR. MARIO ANDRES ARAGON PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA.0003091	CO

General Provider Information

NPI Number	:	1073822664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARIO ANDRES ARAGON PA-C

Provider Business Mailing Address
First Line	:	9320 GRAND CORDERA PKWY STE 100
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80924-7004
Country	:	US
Telephone Number	:	719-282-6337
Fax Number	:	719-282-0532

Provider Business Practice Location Address
First Line	:	9320 GRAND CORDERA PKWY
Second Line	:	STE 100
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80924-7003
Country	:	US
Telephone Number	:	719-282-6337
Fax Number	:	719-282-0532

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2010
Last Update Date	:	12/18/2019

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