Provider Demographics
NPI:1205859519
Name:DELMONT, DANIEL M
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:M
Last Name:DELMONT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 CLEVELAND AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-7182
Mailing Address - Country:US
Mailing Address - Phone:239-936-6778
Mailing Address - Fax:
Practice Address - Street 1:3210 CLEVELAND AVE STE 100
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-7182
Practice Address - Country:US
Practice Address - Phone:239-936-6778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102178363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL592207264001OtherCHAMPUS
FL592207264EOtherHUMANA
FL0664623OtherAETNA HMO
FL0905529OtherUHC
FL57526OtherBCBS
FL592207264OtherCIGNA PPO
FL252112100Medicaid
FL5522534OtherAETNA PPO
FL225715OtherGHI PPO
FL9081708001OtherCIGNA HMO
FL0626040001Medicare NSC
FL225715OtherGHI PPO
FL0664623OtherAETNA HMO
FL57526OtherBCBS
FL252112100Medicaid