Provider Demographics
NPI:1508901521
Name:DELGADO, JORGE RAFAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:RAFAEL
Last Name:DELGADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JORGE
Other - Middle Name:R
Other - Last Name:DELGADO-UGAZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:19000 SW 377TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33034
Mailing Address - Country:US
Mailing Address - Phone:786-349-2358
Mailing Address - Fax:
Practice Address - Street 1:19000 SW 377TH ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33034
Practice Address - Country:US
Practice Address - Phone:786-349-2358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR016383208D00000X
FLACN 287208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLACN 287OtherFLORIDA' S MD LICENSE
FLACN 287OtherFLORIDA' S MD LICENSE