MEDICARE: DR. AARON TANNER POOLE M.D.

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	207V00000X	Obstetrics & Gynecology Physician	P2509	TX
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207VM0101X	Maternal & Fetal Medicine Physician	P2509	TX

General Provider Information

NPI Number	:	1205917614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AARON TANNER POOLE M.D.

Provider Business Mailing Address
First Line	:	10175 GATEWAY BLVD W STE 210
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79925-7618
Country	:	US
Telephone Number	:	915-599-8887
Fax Number	:	915-599-8965

Provider Business Practice Location Address
First Line	:	10175 GATEWAY BLVD W STE 210
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79925-7618
Country	:	US
Telephone Number	:	915-599-8887
Fax Number	:	915-599-8965

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

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	04/30/2021

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