MEDICARE: ANGELA E ASOM 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	208000000X	Pediatrics Physician	L8604	TX
2	208000000X	Pediatrics Physician	MD2023-1277	NM
3	208000000X	Pediatrics Physician	35C.003939	OH
4	208000000X	Pediatrics Physician	MA69683	NJ
5	208000000X	Pediatrics Physician	MD058635L	PA

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	L8604	OTHER	TX	TX LICENSE

General Provider Information

NPI Number	:	1497762629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA E ASOM MD

Provider Business Mailing Address
First Line	:	421 PALOMINO WAY
Second Line	:
City	:	FAIRVIEW
State	:	TX
Zip	:	75069-1531
Country	:	US
Telephone Number	:	469-585-7721
Fax Number	:

Provider Business Practice Location Address
First Line	:	717 S GREENVILLE AVE
Second Line	:	STE 104
City	:	ALLEN
State	:	TX
Zip	:	75002-3317
Country	:	US
Telephone Number	:	972-396-1900
Fax Number	:	972-396-1901

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

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	06/04/2026

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Directions to “ ANGELA E ASOM MD” Practice Location

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