Provider Demographics
NPI:1508070038
Name:LUIS DELGADO JR MD PA
Entity Type:Organization
Organization Name:LUIS DELGADO JR MD PA
Other - Org Name:NORTHSIDE FAMILY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DELGADO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:956-631-3831
Mailing Address - Street 1:5128 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2834
Mailing Address - Country:US
Mailing Address - Phone:956-631-3831
Mailing Address - Fax:956-618-5140
Practice Address - Street 1:5128 N 10TH ST
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2834
Practice Address - Country:US
Practice Address - Phone:956-631-3831
Practice Address - Fax:956-631-5537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4279207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX217464101Medicaid
TX111744202Medicaid
TX111744204Medicaid
TX217464102Medicaid
TXDR8589OtherRAILROAD MEDICARE
TX111744203OtherMEDICAID EPSDT
TX111744203OtherMEDICAID EPSDT
TX217464101Medicaid
TX111744202Medicaid