Individual
GREGG D'ANGELO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
11882 GREENVILLE AVE STE 121, DALLAS, TX 75243-3567
(972) 424-9212
(972) 509-1450
Mailing address
11882 GREENVILLE AVE STE 121, DALLAS, TX 75243-3567
(972) 424-9212
(972) 509-1450
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
24947
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0310641 02
—
TX
01
—
24947
TEXAS LICENSE
TX
01
—
86850A
BLUE CROSS ID W/IN GROUP
TX
Enumeration date
08/11/2006
Last updated
09/17/2014
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