Provider Demographics
NPI:1790753556
Name:DELGADO, JAMES RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:RICHARD
Last Name:DELGADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:5 PETROGLYPH CIR
Mailing Address - Street 2:SUIGE A
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87506-1001
Mailing Address - Country:US
Mailing Address - Phone:505-455-1962
Mailing Address - Fax:505-455-2355
Practice Address - Street 1:5 PETROGLYPH CIR
Practice Address - Street 2:SUIGE A
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87506-1001
Practice Address - Country:US
Practice Address - Phone:505-455-1962
Practice Address - Fax:505-455-2355
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2011-11-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NM99-36207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM009728OtherBCBS NM
810852486OtherPHCS
NMA9672Medicaid
PROVP12114OtherMOLINA
201018320OtherPRESBYTERIAN HEALTH PLANS
2335621OtherUHC
32464OtherLOVELACE
G94899Medicare UPIN