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General NPI Number Information
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NPI Number | 1568764975
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Entity Type | Organization
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Legal Business Name | BRYAN N ANGLE MD PA
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Dates
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Enumeration Date | 11/18/2010
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Last Update Date | 10/30/2012
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Provider Practice Location Address
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Address Line | 303 W HARRIS AVE SUITE 3
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City | SAN ANGELO
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State | TX
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Zip | 76903-6377
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Country | US
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Telephone | 325-942-9300
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Fax | 325-942-9333
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Provider Business Mailing Address
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Address Line | 303 W HARRIS AVE SUITE 3
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City | SAN ANGELO
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State | TX
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Zip | 76903-6377
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Country | US
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Telephone | 325-942-9300
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Fax | 325-942-9333
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRYAN N ANGLE
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Credential | M.D.
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Telephone | 325-942-9300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | J1844
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License Number State | TX
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