Provider Demographics
NPI:1912011271
Name:FAMECHON, ANGELA SHIH (MD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:SHIH
Last Name:FAMECHON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:SHIH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:11673 JOLLYVILLE RD
Mailing Address - Street 2:SUITE B 101
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4200
Mailing Address - Country:US
Mailing Address - Phone:512-339-1535
Mailing Address - Fax:512-339-1526
Practice Address - Street 1:11673 JOLLYVILLE RD
Practice Address - Street 2:SUITE B 101
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4200
Practice Address - Country:US
Practice Address - Phone:512-339-1535
Practice Address - Fax:512-339-1526
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3824207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8641B8Medicare PIN