Provider Demographics
NPI:1366460958
Name:DELGADO, JOHN I (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:I
Last Name:DELGADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3001 EXECUTIVE DR STE 130
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33762-5323
Mailing Address - Country:US
Mailing Address - Phone:727-347-0005
Mailing Address - Fax:727-541-6558
Practice Address - Street 1:2919 W SWANN AVE STE 106
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4049
Practice Address - Country:US
Practice Address - Phone:813-930-2829
Practice Address - Fax:727-930-9522
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME54871207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063150700Medicaid
FL210981OtherAVMED
FL063150700Medicaid
FL210981OtherAVMED