MEDICARE: PIERRE EDOUARD DE DELVA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	21552	MS
2	208600000X	Surgery Physician	MD441215	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P01195517	OTHER	MS	RAILROAD MEDICARE PTAN

General Provider Information

NPI Number	:	1043294432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PIERRE EDOUARD DE DELVA MD

Provider Business Mailing Address
First Line	:	2500 N STATE ST
Second Line	:	UNIVERSITY OF MISSISSIPPI MEDICAL CENTER
City	:	JACKSON
State	:	MS
Zip	:	39216-4500
Country	:	US
Telephone Number	:	601-984-5170
Fax Number	:

Provider Business Practice Location Address
First Line	:	971 LAKELAND DR STE 657
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39216-4608
Country	:	US
Telephone Number	:	601-200-2780
Fax Number	:	601-200-2788

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	11/11/2025

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