Basic Information
| Provider Information | |||||||||
| NPI: | 1740493493 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PEMBERTON | ||||||||
| FirstName: | AARON | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 911 E 20TH ST STE 300 | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571051045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053221300 | ||||||||
| FaxNumber: | 6053221301 | ||||||||
| Practice Location | |||||||||
| Address1: | 911 E 20TH ST STE 300 | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571051045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053221300 | ||||||||
| FaxNumber: | 6053221301 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | A121481 | CA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | Q9230 | TX | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 10226 | SD | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 00AX91410 | 05 | CA | MEDICAID | 359386501 | 05 | TX | MEDICAID |