MEDICARE: AEGIS MEDICAL CARE OF AZ, PC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1740242460
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AEGIS MEDICAL CARE OF AZ, PC

Provider Business Mailing Address
First Line	:	20470 N LAKE PLEASANT RD
Second Line	:	SUITE 110
City	:	PEORIA
State	:	AZ
Zip	:	85382-9708
Country	:	US
Telephone Number	:	623-266-4699
Fax Number	:	623-825-5630

Provider Business Practice Location Address
First Line	:	20470 N LAKE PLEASANT RD
Second Line	:	SUITE 110
City	:	PEORIA
State	:	AZ
Zip	:	85382-9708
Country	:	US
Telephone Number	:	623-266-4699
Fax Number	:	623-825-5630

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	DR. AARON BRADLEY BOOR
Credential	:	D.O.
Telephone Number	:	623-266-4699

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	08/22/2020

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