Basic Information
| Provider Information | |||||||||
| NPI: | 1669788493 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JOHN ISAAC DELGADO M D P A | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 24226 | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336234226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139302829 | ||||||||
| FaxNumber: | 8139309522 | ||||||||
| Practice Location | |||||||||
| Address1: | 2919 W SWANN AVE | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336094038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139302829 | ||||||||
| FaxNumber: | 8139309522 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2010 | ||||||||
| LastUpdateDate: | 11/18/2010 | ||||||||
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| AuthorizedOfficialLastName: | DELGADO | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | ISAAC | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8139302829 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | ME0054871 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.