Basic Information
| Provider Information | |||||||||
| NPI: | 1083892020 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DELGADO | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | P | ||||||||
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| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 148 E HERSEY ST | ||||||||
| Address2: | |||||||||
| City: | ASHLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413264777 | ||||||||
| FaxNumber: | 5417086372 | ||||||||
| Practice Location | |||||||||
| Address1: | 148 E HERSEY ST | ||||||||
| Address2: | |||||||||
| City: | ASHLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413264777 | ||||||||
| FaxNumber: | 5417086372 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2008 | ||||||||
| LastUpdateDate: | 03/04/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VX0000X | G63783 | CA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Obstetrics | 207Q00000X | G63783 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD16862 | OR | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 010194 | 05 | OR | MEDICAID |