Provider Demographics
NPI:1497723514
Name:DELAUNE, ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:DELAUNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 BEAM AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-1127
Mailing Address - Country:US
Mailing Address - Phone:651-779-7978
Mailing Address - Fax:651-779-7656
Practice Address - Street 1:1580 BEAM AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1127
Practice Address - Country:US
Practice Address - Phone:651-779-7978
Practice Address - Fax:651-779-7656
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN39955207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1012984OtherPREFERRED ONE
MN3600017OtherMEDICA
MN120217OtherUCARE MN
WI32335100Medicaid
MNHP22811OtherHEALTHPARTNERS
IL454410207Medicaid
MN676089OtherAMERICA'S PPO
MN930025200Medicaid
MN02R67DEOtherBLUE CROSS BLUE SHIELD MN
MNG49790Medicare UPIN
MN676089OtherAMERICA'S PPO
MN120217OtherUCARE MN