Provider Demographics
NPI:1821308032
Name:MOUNT, ANGELA C (DO)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:C
Last Name:MOUNT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 NE 7TH ST STE D
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-1450
Mailing Address - Country:US
Mailing Address - Phone:541-244-2197
Mailing Address - Fax:541-244-2199
Practice Address - Street 1:1215 NE 7TH ST STE D
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1450
Practice Address - Country:US
Practice Address - Phone:541-244-2197
Practice Address - Fax:541-244-2199
Is Sole Proprietor?:No
Enumeration Date:2010-10-21
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT013874207Q00000X
ORD0163300207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine