Provider Demographics
NPI:1922031897
Name:DELIN, JACQUELYN B (MD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELYN
Middle Name:B
Last Name:DELIN
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 1:601 CLARA BARTON BLVD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-5738
Mailing Address - Country:US
Mailing Address - Phone:972-487-9940
Mailing Address - Fax:972-485-8769
Practice Address - Street 1:601 CLARA BARTON BLVD
Practice Address - Street 2:SUITE 160
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-5738
Practice Address - Country:US
Practice Address - Phone:972-487-9940
Practice Address - Fax:972-485-8769
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6028207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158852701Medicaid
TX180391803Medicaid
TX8G0558OtherBCBS
TX180391802Medicaid
TX180391805Medicaid
TX180391804Medicaid
TX8A5214Medicare PIN
TX180391803Medicaid
TXP00034396Medicare PIN