Basic Information
Provider Information | |||||||||
NPI: | 1265403869 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | TRONE | ||||||||
FirstName: | AARON | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | MR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | TRONE | ||||||||
OtherFirstName: | AARON | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: | MR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | D.O. | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 2305 GEORGIA ST | ||||||||
Address2: |   | ||||||||
City: | LOUISIANA | ||||||||
State: | MO | ||||||||
PostalCode: | 633532559 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5737544584 | ||||||||
FaxNumber: | 5737545280 | ||||||||
Practice Location | |||||||||
Address1: | 425 N GALLOWAY RD | ||||||||
Address2: |   | ||||||||
City: | VANDALIA | ||||||||
State: | MO | ||||||||
PostalCode: | 633821259 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5735942111 | ||||||||
FaxNumber: | 5735942040 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/31/2006 | ||||||||
LastUpdateDate: | 05/20/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 05/20/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 111273 | MO | Y |   | Allopathic & Osteopathic Physicians | General Practice |   |
ID Information
ID | Type | State | Issuer | Description | 245766605 | 05 | MO |   | MEDICAID |