Provider Demographics
NPI:1427184944
Name:DELEASA, GAIL M (MD)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:M
Last Name:DELEASA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10725 SANDY RUN RD
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33478-6849
Mailing Address - Country:US
Mailing Address - Phone:561-741-7534
Mailing Address - Fax:
Practice Address - Street 1:1335 W INDIANTOWN RD
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-4631
Practice Address - Country:US
Practice Address - Phone:561-744-9995
Practice Address - Fax:561-744-8215
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0076092207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD03486Medicare UPIN
FLE1766ZMedicare ID - Type Unspecified