1801067194 NPI number — GABRIEL F DELGADO DPM PA

Table of content: (NPI 1801067194)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801067194 NPI number — GABRIEL F DELGADO DPM PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GABRIEL F DELGADO DPM PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801067194
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
203 KERNEYWOOD STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKELAND
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33803-2947
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
863-686-1641
Provider Business Mailing Address Fax Number:
863-802-5693

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
203 KERNEYWOOD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKELAND
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33803-2947
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-686-1641
Provider Business Practice Location Address Fax Number:
863-802-5693
Provider Enumeration Date:
03/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
DELGADO
Authorized Official First Name:
GABRIEL
Authorized Official Middle Name:
FELIX
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
863-686-1641

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1992776975 . This is a "NPI PERSONAL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 016146300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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