Provider Demographics
NPI:1114922499
Name:DELGADO, LUIS JR (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS JR
Middle Name:
Last Name:DELGADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:LUIS
Other - Middle Name:
Other - Last Name:DELGADO
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5128 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2834
Mailing Address - Country:US
Mailing Address - Phone:956-631-3831
Mailing Address - Fax:956-618-5140
Practice Address - Street 1:5128 N 10TH ST
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2834
Practice Address - Country:US
Practice Address - Phone:956-631-3831
Practice Address - Fax:956-618-5140
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2016-02-17
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
TXH4279207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111744204Medicaid
TX080080135OtherMEDICARE, RR
TX111744202Medicaid
TX111744203Medicaid
TX111744203OtherEPSDT
TXE45816Medicare UPIN
TXTXB101360Medicare PIN
TX00F05HMedicare PIN