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NPI Code Detail

MEDICARE: LINDA DELO DO PA

MEDICARE: LINDA DELO DO PA
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
1261QP2300XPrimary Care Clinic/CenterOS05326FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
182976OTHERFLBCBS
20112160OTHERFLGHI
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1861535726
Entity Type Code : Organization
Provider Name (Legal Business Name) : LINDA DELO DO PA
Provider Business Mailing Address
First Line : 514 SE PORT ST LUCIE BLVD
Second Line :
City : PORT SAINT LUCIE
State : FL
Zip : 34984-5150
Country : US
Telephone Number : 772-871-5900
Fax Number : 772-871-1197
Provider Business Practice Location Address
First Line : 514 SE PORT ST LUCIE BLVD
Second Line :
City : PORT SAINT LUCIE
State : FL
Zip : 34984-5150
Country : US
Telephone Number : 772-871-5900
Fax Number : 772-871-1197
Authorized Official
Title or Position : PRESIDENT
Name : DR. LINDA FAY DELO
Credential : D.O.
Telephone Number : 772-871-5900
Provider Enumeration Date : 02/14/2007
Last Update Date : 07/09/2010

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Directions to “LINDA DELO DO PA ” Practice Location

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