Provider Demographics
NPI:1124051800
Name:OLIVER, ANGELLE M (MD)
Entity type:Individual
Prefix:
First Name:ANGELLE
Middle Name:M
Last Name:OLIVER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANGELLE
Other - Middle Name:M
Other - Last Name:FERRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6210 US-290
Mailing Address - Street 2:SUITE 240
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723
Mailing Address - Country:US
Mailing Address - Phone:512-231-5506
Mailing Address - Fax:512-406-6216
Practice Address - Street 1:10401 ANDERSON MILL RD
Practice Address - Street 2:SUITE 110B
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-2581
Practice Address - Country:US
Practice Address - Phone:512-250-5571
Practice Address - Fax:512-406-7300
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5157208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX186760801Medicaid
TX186760805Medicaid
TX186760802Medicaid
TX186760803Medicaid
TX186760805Medicaid
TX186760801Medicaid
TXTXB118305Medicare PIN
TX8J2225Medicare PIN