Provider Demographics
NPI:1346241494
Name:SMOGUR, ANGELA M (PA)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:SMOGUR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:M
Other - Last Name:WEGMANN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:AUSTIN HEART PLLC
Mailing Address - Street 2:PO BOX 402669
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-2669
Mailing Address - Country:US
Mailing Address - Phone:512-206-4300
Mailing Address - Fax:512-206-4350
Practice Address - Street 1:3801 N LAMAR BLVD
Practice Address - Street 2:STE 300 AUSTIN HEART
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-4080
Practice Address - Country:US
Practice Address - Phone:512-206-3600
Practice Address - Fax:512-454-2581
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA0011A207RC0000X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1959603-01Medicaid
TX1959603-01Medicaid
TXTXB113231Medicare PIN