Provider Demographics
NPI:1750347779
Name:DELVA, GESNER (MD)
Entity type:Individual
Prefix:DR
First Name:GESNER
Middle Name:
Last Name:DELVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6080 SW 180TH TER
Mailing Address - Street 2:
Mailing Address - City:SOUTHWEST RANCHES
Mailing Address - State:FL
Mailing Address - Zip Code:33331-1604
Mailing Address - Country:US
Mailing Address - Phone:954-680-3813
Mailing Address - Fax:
Practice Address - Street 1:85 NE 168 STREET
Practice Address - Street 2:SUITE B
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33169
Practice Address - Country:US
Practice Address - Phone:305-653-0013
Practice Address - Fax:305-653-0590
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0064836208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF75038Medicare UPIN
FL23776Medicare ID - Type Unspecified