Provider Demographics
NPI:1629059175
Name:DELGADO, GREGG (DO)
Entity Type:Individual
Prefix:
First Name:GREGG
Middle Name:
Last Name:DELGADO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 COMPASS POINT DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-7993
Mailing Address - Country:US
Mailing Address - Phone:256-464-8467
Mailing Address - Fax:
Practice Address - Street 1:342 COX BLVD
Practice Address - Street 2:
Practice Address - City:SHEFFIELD
Practice Address - State:AL
Practice Address - Zip Code:35660-4020
Practice Address - Country:US
Practice Address - Phone:256-383-4473
Practice Address - Fax:256-381-5232
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO8472085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1326373861OtherGROUP NPI
AL009982135Medicaid
AL51000602OtherBCBS OF AL
ALE869Medicare ID - Type UnspecifiedMEDICARE GROUP ID #
AL009982135Medicaid
ALF05643Medicare UPIN