1306138912 NPI number — DR. JAMES BENJAMIN ANGEL M.D.

Table of content: DR. JAMES BENJAMIN ANGEL M.D. (NPI 1306138912)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306138912 NPI number — DR. JAMES BENJAMIN ANGEL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANGEL
Provider First Name:
JAMES
Provider Middle Name:
BENJAMIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ANGEL
Provider Other First Name:
BEN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1306138912
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/24/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1698 OLD LEBANON RD
Provider Second Line Business Mailing Address:
STE 3B
Provider Business Mailing Address City Name:
CAMPBELLSVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42718-9662
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-257-3533
Provider Business Mailing Address Fax Number:
859-323-1944

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 ROSE STREET
Provider Second Line Business Practice Location Address:
UNIVERSITY OF KENTUCKY
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40505-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-257-3533
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/15/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  49057 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)