Provider Demographics
NPI:1033675954
Name:VILCHIS, ANGEL (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ANGEL
Middle Name:
Last Name:VILCHIS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:ANGEL
Other - Middle Name:
Other - Last Name:VILCHIS-FLORES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 175
Mailing Address - Street 2:
Mailing Address - City:BROMIDE
Mailing Address - State:OK
Mailing Address - Zip Code:74530-0175
Mailing Address - Country:US
Mailing Address - Phone:580-380-7627
Mailing Address - Fax:
Practice Address - Street 1:1841 BELLE ISLE BLVD STE L
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-4226
Practice Address - Country:US
Practice Address - Phone:405-445-7504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-15
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2799363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant