Provider Demographics
NPI:1275500647
Name:ANGEL, JANE C (MD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:C
Last Name:ANGEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5035 OAKMONT DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-7640
Mailing Address - Country:US
Mailing Address - Phone:409-924-7391
Mailing Address - Fax:
Practice Address - Street 1:5035 OAKMONT DR
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-7640
Practice Address - Country:US
Practice Address - Phone:409-924-7391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3065174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNK3065OtherMEDICAL LICENSE
TXP081Y8470Medicaid
TXP081Y8470Medicaid
TNK3065OtherMEDICAL LICENSE