Provider Demographics
NPI:1811931587
Name:DELIZIO, PASQUALE ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:PASQUALE
Middle Name:ROBERT
Last Name:DELIZIO
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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:5400 KELL WEST BLVD
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76310
Practice Address - Country:US
Practice Address - Phone:940-691-8271
Practice Address - Fax:940-692-2042
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE7047207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138319202Medicaid
TX138319205Medicaid
TX138319210Medicaid
TX138319203Medicaid
TX8R1423OtherBLUE CROSS OF TEXAS
TX138319201OtherCSHCN
TX138319204Medicaid
OK100014190AMedicaid
TX138319203Medicaid
TX110138539Medicare PIN
TX83540FMedicare PIN
TX138319201OtherCSHCN