Provider Demographics
NPI:1598738288
Name:DELTOR, DOMINIQUE C (MD)
Entity Type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:C
Last Name:DELTOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13527 49TH ST N
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-8142
Mailing Address - Country:US
Mailing Address - Phone:561-514-1570
Mailing Address - Fax:
Practice Address - Street 1:7040 SEMINOLE PRATT WHITNEY RD STE 25-6
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-5714
Practice Address - Country:US
Practice Address - Phone:561-352-4001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86358207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I24853Medicare UPIN
FL62863ZMedicare ID - Type Unspecified
FL62863YMedicare ID - Type Unspecified