Provider Demographics
NPI:1003831421
Name:DELISLE, CHRISTOPHER W (DO)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:W
Last Name:DELISLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 LEARNING WAY
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32306-4178
Mailing Address - Country:US
Mailing Address - Phone:850-644-6230
Mailing Address - Fax:850-644-4251
Practice Address - Street 1:960 LEARNING WAY
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32306-4178
Practice Address - Country:US
Practice Address - Phone:850-644-6230
Practice Address - Fax:850-644-4251
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9394207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277511500Medicaid
FLP00683811OtherRR MEDICARE
FLDN5565OtherGROUP RR MEDICARE
FLOS9394OtherLICENSE
1003831421OtherNPI NUMBER
FLP00683811OtherRR MEDICARE
FLOS9394OtherLICENSE
FL277511500Medicaid
FLDN5565OtherGROUP RR MEDICARE