MEDICARE: DR. JEFF OLIVER ANGOBALDO 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	208200000X	Plastic Surgery Physician	M8498	TX

General Provider Information

NPI Number	:	1134304579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFF OLIVER ANGOBALDO M.D.

Provider Business Mailing Address
First Line	:	5880 ASHMILL DR
Second Line	:	STE 200
City	:	PLANO
State	:	TX
Zip	:	75024-0031
Country	:	US
Telephone Number	:	972-378-3870
Fax Number	:	972-378-7977

Provider Business Practice Location Address
First Line	:	6105 WINDCOM CT
Second Line	:	SUITE 150
City	:	PLANO
State	:	TX
Zip	:	75093-7889
Country	:	US
Telephone Number	:	972-378-3870
Fax Number	:	972-378-7977

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

Provider Enumeration Date	:	01/03/2008
Last Update Date	:	04/24/2020

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