Basic Information
Provider Information
NPI: 1184203002
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SAUL
FirstName: AARON
MiddleName: DALE
NamePrefix: MR.
NameSuffix: JR.
Credential: APRN-CNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 113 PLEASANT VALLEY DR STE 210
Address2:  
City: BOERNE
State: TX
PostalCode: 780065683
CountryCode: US
TelephoneNumber: 8302674575
FaxNumber: 8302674575
Practice Location
Address1: 113 PLEASANT VALLEY DR STE 210
Address2:  
City: BOERNE
State: TX
PostalCode: 780065683
CountryCode: US
TelephoneNumber: 8302674575
FaxNumber: 8302674575
Other Information
ProviderEnumerationDate: 04/07/2021
LastUpdateDate: 04/07/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/07/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000X1032131TXY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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