Provider Demographics
NPI:1093728602
Name:ARAGON, AMAURY (PA-C)
Entity type:Individual
Prefix:
First Name:AMAURY
Middle Name:
Last Name:ARAGON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5134
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-1134
Mailing Address - Country:US
Mailing Address - Phone:305-463-6690
Mailing Address - Fax:305-463-6693
Practice Address - Street 1:7142 LAUREL LN
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2664
Practice Address - Country:US
Practice Address - Phone:305-463-6690
Practice Address - Fax:305-463-6693
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101047363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL290740200Medicaid
FLY00VVOtherBC BS OF FLORIDA
FLE2871UMedicare ID - Type Unspecified
FL290740200Medicaid