Provider Demographics
NPI:1255449070
Name:ANGEL, JOSE (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:
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 1:29410 340TH TRL
Mailing Address - Street 2:
Mailing Address - City:ADEL
Mailing Address - State:IA
Mailing Address - Zip Code:50003-8540
Mailing Address - Country:US
Mailing Address - Phone:515-707-6697
Mailing Address - Fax:319-356-3086
Practice Address - Street 1:7951 EP TRUE PKWY
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8107
Practice Address - Country:US
Practice Address - Phone:515-707-6697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-25966207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA3510OtherMIDLANDS CHOICE
IA067117OtherHEALTH ALLIANCE
IA28100OtherWELLMARK BLUE SHIELD
IA4275925Medicaid
IA2275925Medicaid
IAI0418Medicare ID - Type Unspecified
IAI18863Medicare ID - Type Unspecified
IA28100OtherWELLMARK BLUE SHIELD