Provider Demographics
NPI:1922069954
Name:CANCEL-JIMENEZ, ANGEL R (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:R
Last Name:CANCEL-JIMENEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ANGEL
Other - Middle Name:R
Other - Last Name:CANCEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1613 HARRISON PKWY
Mailing Address - Street 2:STE. 200
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2896
Mailing Address - Country:US
Mailing Address - Phone:800-437-2672
Mailing Address - Fax:954-616-3591
Practice Address - Street 1:700 W OAK ST
Practice Address - Street 2:DEPT OF ANESTHESIA
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741
Practice Address - Country:US
Practice Address - Phone:407-846-2266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME106141207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL148VNOtherBLUE CROSS BLUE SHIELD FLORIDA
FL002349000Medicaid
FLDH133ZMedicare UPIN
FL002349000Medicaid