Healthcare Provider Details

I. General information

NPI: 1821063777
Provider Name (Legal Business Name): ANGELA GOWDY MYSLIWIEC MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 10/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3551 ROGER BROOKE DRIVE BROOKE ARMY MEDICAL CENTER
FORT SAM HOUSTON TX
78234-1000
US

IV. Provider business mailing address

223 CORONA AVE
SAN ANTONIO TX
78209-4524
US

V. Phone/Fax

Practice location:
  • Phone: 210-295-6239
  • Fax:
Mailing address:
  • Phone: 210-788-1878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number10205
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: