Provider Demographics
NPI:1255472205
Name:ANGULO, FREDDY (MD)
Entity type:Individual
Prefix:DR
First Name:FREDDY
Middle Name:
Last Name:ANGULO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:FREDDY
Other - Middle Name:PERNETT
Other - Last Name:ANGULO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:139 KINROSS DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-2214
Mailing Address - Country:US
Mailing Address - Phone:210-921-3800
Mailing Address - Fax:
Practice Address - Street 1:1619 E COMMON ST STE 1201
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-3464
Practice Address - Country:US
Practice Address - Phone:830-620-0330
Practice Address - Fax:830-620-5405
Is Sole Proprietor?:No
Enumeration Date:2007-02-11
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 98590207R00000X
TXN2380207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine