MEDICARE: JOSE M ANGELES MD

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	207R00000X	Internal Medicine Physician	31900	AZ

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	:	1447322441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE M ANGELES MD

Provider Business Mailing Address
First Line	:	13350 N 94TH DR
Second Line	:	SUITE A101
City	:	PEORIA
State	:	AZ
Zip	:	85381-4826
Country	:	US
Telephone Number	:	623-933-1010
Fax Number	:	623-933-3383

Provider Business Practice Location Address
First Line	:	13350 N 94TH DR
Second Line	:	SUITE A101
City	:	PEORIA
State	:	AZ
Zip	:	85381-4826
Country	:	US
Telephone Number	:	623-933-1010
Fax Number	:	623-933-3383

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

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	04/14/2008

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Directions to “ JOSE M ANGELES MD” Practice Location

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