Provider Demographics
NPI:1477551497
Name:DELVALLE, EMILIO (MD)
Entity Type:Individual
Prefix:
First Name:EMILIO
Middle Name:
Last Name:DELVALLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1860 BOY SCOUT DR
Mailing Address - Street 2:STE 201
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-2119
Mailing Address - Country:US
Mailing Address - Phone:239-215-1180
Mailing Address - Fax:239-215-1179
Practice Address - Street 1:6300 CORPORATE CT
Practice Address - Street 2:STE 103
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-3513
Practice Address - Country:US
Practice Address - Phone:239-277-7666
Practice Address - Fax:239-277-1064
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2018-04-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME55848208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL064251700Medicaid
FL064251700Medicaid