Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | OS3836 | FL |
NPI | 1043326150 |
---|---|
Provider Name | Dr. Don S Angelo |
First Address | Pensacola, FL 32504-8756 |
Second Address | Pensacola, FL 32504-8756 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2006 |
Last Update Date | 13/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D70566 | (02) |