Provider Demographics
NPI:1972983344
Name:AARON J AFFLECK MD PA
Entity type:Organization
Organization Name:AARON J AFFLECK MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:JON
Authorized Official - Last Name:AFFLECK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-523-6868
Mailing Address - Street 1:2900 VALENCIA DR
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7594
Mailing Address - Country:US
Mailing Address - Phone:208-523-6868
Mailing Address - Fax:
Practice Address - Street 1:2900 VALENCIA DR
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7594
Practice Address - Country:US
Practice Address - Phone:208-523-6868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM8206332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002797900Medicaid
IDH40444Medicare UPIN
ID11008621Medicare PIN