Healthcare Provider Details

I. General information

NPI: 1629059175
Provider Name (Legal Business Name): GREGG DELGADO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 04/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 COX BLVD
SHEFFIELD AL
35660-4020
US

IV. Provider business mailing address

101 COMPASS POINT DR
MADISON AL
35758-7993
US

V. Phone/Fax

Practice location:
  • Phone: 256-383-4473
  • Fax: 256-381-5232
Mailing address:
  • Phone: 256-464-8467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberDO847
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: