Healthcare Provider Details

I. General information

NPI: 1215927371
Provider Name (Legal Business Name): HERMINIO CUERVO-DELGADO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 03/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 WILLIAMSBURG SQ
LAKELAND FL
33803-4279
US

IV. Provider business mailing address

1601 WILLIAMSBURG SQ
LAKELAND FL
33803-4279
US

V. Phone/Fax

Practice location:
  • Phone: 863-647-1684
  • Fax: 863-647-2824
Mailing address:
  • Phone: 863-647-1684
  • Fax: 863-647-2824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME31030
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: