MEDICARE: JONATHAN PATRICK ANGEL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	R9710	TX

General Provider Information

NPI Number	:	1013448117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN PATRICK ANGEL M.D.

Provider Business Mailing Address
First Line	:	117 MEDICAL CIR
Second Line	:
City	:	ATHENS
State	:	TX
Zip	:	75751-9003
Country	:	US
Telephone Number	:	903-676-3200
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 N BEACH ST STE 104
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76111-7070
Country	:	US
Telephone Number	:	817-831-1750
Fax Number	:	817-831-1750

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2017
Last Update Date	:	05/02/2024

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