Basic Information
| Provider Information | |||||||||
| NPI: | 1285626994 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GILES | ||||||||
| FirstName: | DELTON | ||||||||
| MiddleName: | KEITH | ||||||||
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| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1211 HIGHWAY 6 | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | SUGAR LAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774784941 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2814944832 | ||||||||
| FaxNumber: | 2814947399 | ||||||||
| Practice Location | |||||||||
| Address1: | 3803 FM 1092 RD | ||||||||
| Address2: | |||||||||
| City: | MISSOURI CITY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774592209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2814038271 | ||||||||
| FaxNumber: | 2814038274 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2005 | ||||||||
| LastUpdateDate: | 05/22/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA02776 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 8S1110 | 01 | TX | BCBS | OTHER |