Provider Demographics
NPI:1043242001
Name:ANGLETON, PAUL M (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:M
Last Name:ANGLETON
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:PO BOX 843966
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3966
Mailing Address - Country:US
Mailing Address - Phone:573-884-3300
Mailing Address - Fax:573-884-0943
Practice Address - Street 1:3916 S PROVIDENCE RD STE 101
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-7152
Practice Address - Country:US
Practice Address - Phone:573-882-1662
Practice Address - Fax:573-882-4096
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013002755207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036115645Medicaid
IL809840Medicare ID - Type UnspecifiedGROUP #
ILK29541Medicare ID - Type UnspecifiedINDIVIDUAL #
IL036115645Medicaid