Provider Demographics
NPI:1598761934
Name:CAGLE, DONALD E (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:E
Last Name:CAGLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:320 RUSSELL BLVD
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-1240
Mailing Address - Country:US
Mailing Address - Phone:936-569-6411
Mailing Address - Fax:936-569-6446
Practice Address - Street 1:320 RUSSELL BLVD
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1240
Practice Address - Country:US
Practice Address - Phone:936-569-6411
Practice Address - Fax:936-569-6446
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF7713208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1547184-01Medicaid
TX8G8160OtherBCBS PROV ID
TX00000021JKOtherBCBS PROV #
TX751702073OtherAETNA PROV #
TX827023082OtherRR MEDICARE
TX1547184-01Medicaid
TX00000021JKOtherBCBS PROV #