Provider Demographics
NPI:1497780357
Name:DELROWE, DANIEL J (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:DELROWE
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:PO BOX 9077
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34985-9077
Mailing Address - Country:US
Mailing Address - Phone:772-337-2020
Mailing Address - Fax:772-337-1704
Practice Address - Street 1:1715 SE TIFFANY AVE
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7520
Practice Address - Country:US
Practice Address - Phone:772-337-2020
Practice Address - Fax:772-337-1704
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME52991207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL372279100Medicaid
FL05952OtherBLUE CROSS BLUE SHIELD FLORIDA
FL372279100Medicaid
FL05952ZMedicare PIN
FL05952OtherBLUE CROSS BLUE SHIELD FLORIDA