Provider Demographics
NPI:1861475147
Name:FANGMEIER, ANGELA ANNE (MD)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:ANNE
Last Name:FANGMEIER
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 1:451 S HOLLY ST
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-3018
Mailing Address - Country:US
Mailing Address - Phone:479-549-4228
Mailing Address - Fax:479-549-3711
Practice Address - Street 1:1101-2 N PROGRESS AVE
Practice Address - Street 2:
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-4343
Practice Address - Country:US
Practice Address - Phone:479-549-4228
Practice Address - Fax:479-549-3711
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-2035208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5L060OtherBCBS ARKANSAS
AR136331001Medicaid
OK100252240AMedicaid
AR136331001Medicaid
G86224Medicare UPIN
AR136331001Medicaid