Provider Demographics
NPI:1710192828
Name:BELO, ANGELICA C (MD)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:C
Last Name:BELO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1325
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75671-1325
Mailing Address - Country:US
Mailing Address - Phone:903-927-6680
Mailing Address - Fax:903-927-6681
Practice Address - Street 1:815 S WASHINGTON AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75670-5369
Practice Address - Country:US
Practice Address - Phone:903-927-6880
Practice Address - Fax:903-927-6681
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA242272207RG0100X
TXP4420207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
001621001Medicare PIN