Provider Demographics
NPI:1013448117
Name:ANGEL, JONATHAN PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:PATRICK
Last Name:ANGEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 MEDICAL CIR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-9003
Mailing Address - Country:US
Mailing Address - Phone:903-676-3200
Mailing Address - Fax:
Practice Address - Street 1:400 N BEACH ST STE 104
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76111-7070
Practice Address - Country:US
Practice Address - Phone:817-831-1750
Practice Address - Fax:817-831-1750
Is Sole Proprietor?:No
Enumeration Date:2017-03-21
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR9710207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine