Basic Information
| Provider Information | |||||||||
| NPI: | 1598904740 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DELMAZO | ||||||||
| FirstName: | MIGUEL | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 658 | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305030658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707181122 | ||||||||
| FaxNumber: | 7705334786 | ||||||||
| Practice Location | |||||||||
| Address1: | 3215 MCCLURE BRIDGE RD | ||||||||
| Address2: | |||||||||
| City: | DULUTH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30096 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6783126200 | ||||||||
| FaxNumber: | 6783126226 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2009 | ||||||||
| LastUpdateDate: | 03/03/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 065651 | GA | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 003114073I | 05 | GA | MEDICAID | 003114073G | 05 | GA | MEDICAID | 9738749 | 01 | GA | AETNA | OTHER | 003114073M | 05 | GA | MEDICAID | 02378992 | 01 | GA | AMERIGROUP | OTHER | 003114073J | 05 | GA | MEDICAID | 003114073K | 05 | GA | MEDICAID | 1489990 | 01 | GA | COVENTRY | OTHER | 52515750 | 01 | GA | BCBS | OTHER | 9672923 | 01 | GA | CIGNA | OTHER | 003114073F | 05 | GA | MEDICAID | 003114073N | 05 | GA | MEDICAID | 003114073H | 05 | GA | MEDICAID | 003114073L | 05 | GA | MEDICAID | 1022567 | 01 | GA | WELLCARE | OTHER |