Provider Demographics
NPI:1851390462
Name:ANGEL, JEFFREY L (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:L
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 1:13601 BRUCE B DOWNS BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-4657
Mailing Address - Country:US
Mailing Address - Phone:813-971-6909
Mailing Address - Fax:813-971-6985
Practice Address - Street 1:13601 BRUCE B DOWNS BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4657
Practice Address - Country:US
Practice Address - Phone:813-971-6909
Practice Address - Fax:813-971-6985
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0038567207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL068807000Medicaid
FL068807000Medicaid
FL51149Medicare ID - Type Unspecified