MEDICARE: DR. FERNANDO SAN MIGUEL ANGELES

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	208600000X	Surgery Physician	E7800	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053353144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FERNANDO SAN MIGUEL ANGELES

Provider Business Mailing Address
First Line	:	8808 RACQUET CLUB DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76120-2836
Country	:	US
Telephone Number	:	817-861-3147
Fax Number	:

Provider Business Practice Location Address
First Line	:	11803 S INTERSTATE 35W
Second Line	:	SUITE 354
City	:	FORT WORTH
State	:	TX
Zip	:	76115-0000
Country	:	US
Telephone Number	:	817-293-9140
Fax Number	:	817-293-2392

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

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	11/05/2012

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Directions to “ DR. FERNANDO SAN MIGUEL ANGELES ” Practice Location

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