Provider Demographics
NPI:1942390117
Name:JOHN P DELGADO MD PC
Entity Type:Organization
Organization Name:JOHN P DELGADO MD PC
Other - Org Name:DELGADO FAMILY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHAREE
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-552-1111
Mailing Address - Street 1:148 E HERSEY ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520
Mailing Address - Country:US
Mailing Address - Phone:541-552-1111
Mailing Address - Fax:541-482-9066
Practice Address - Street 1:148 E HERSEY ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520
Practice Address - Country:US
Practice Address - Phone:541-552-1111
Practice Address - Fax:541-482-9066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD16862207Q00000X
ORBD16862207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR010194Medicaid
ORR130815Medicare PIN
OR010194Medicaid
OR138015Medicare PIN
ORR130815Medicare PIN