Organization
ANGEL M. SAN JOSE, M.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANGEL M SAN JOSE M.D. (PRESIDENT)
(276) 935-1168
Entity
Organization
Contact information
Practice address
RR 5 BOX 20, SUITE 207, GRUNDY, VA 24614-9611
(276) 935-1168
(276) 935-1343
Mailing address
RR 5 BOX 20, SUITE 207, GRUNDY, VA 24614-9611
(276) 935-1168
(276) 935-1343
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
0101238113
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
187487
ANTHEM BLUE CROSS BLUE SH
VA
05
—
3810003447
—
WV
05
—
64113434
—
KY
Enumeration date
07/23/2006
Last updated
08/22/2020
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