Provider Demographics
NPI:1164518288
Name:ANGLIN, BETH V (MD)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:V
Last Name:ANGLIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3801 W 15TH ST
Mailing Address - Street 2:BLDG A, SUITE 210
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-4737
Mailing Address - Country:US
Mailing Address - Phone:214-501-5427
Mailing Address - Fax:214-501-5429
Practice Address - Street 1:3801 W 15TH ST
Practice Address - Street 2:BLDG A, SUITE 210
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075
Practice Address - Country:US
Practice Address - Phone:214-501-5427
Practice Address - Fax:214-501-5429
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2018-09-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ6786208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX043634702Medicaid
TXJ6786OtherLICENSE
TX8G3438Medicare ID - Type Unspecified
TXJ6786OtherLICENSE