Angela D Self MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

ANGELA D SELF MD

Practice address

5409 Davis Blvd
North Richland Hills, TX 76180-6827

Phone

(817) 788-1059

Fax

(817) 581-1065

NPI assigned

Jul 2, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Angela D Self, MD

Title

Owner

Phone

(817) 788-1059

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1183334400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184025600000",
    "number": "1104023134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5409 DAVIS BLVD",
            "city": "NORTH RICHLAND HILLS",
            "state": "TX",
            "postal_code": "761806827",
            "telephone_number": "817-788-1059",
            "fax_number": "817-581-1065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5409 DAVIS BLVD",
            "city": "NORTH RICHLAND HILLS",
            "state": "TX",
            "postal_code": "761806827",
            "telephone_number": "817-788-1059",
            "fax_number": "817-581-1065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANGELA D SELF MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-02",
        "last_updated": "2007-07-10",
        "status": "A",
        "authorized_official_last_name": "SELF",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-788-1059",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0043KL",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in North Richland Hills, TX
• Providers in North Richland Hills, TX by specialty
• Internal Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.