Healthcare Provider Details

I. General information

NPI: 1992776975
Provider Name (Legal Business Name): GABRIEL FELIX DELGADO DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 04/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 KERNEYWOOD ST
LAKELAND FL
33803-2947
US

IV. Provider business mailing address

203 KERNEYWOOD ST
LAKELAND FL
33803-2947
US

V. Phone/Fax

Practice location:
  • Phone: 863-686-1641
  • Fax: 863-802-5693
Mailing address:
  • Phone: 863-686-1641
  • Fax: 863-802-5693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO2898
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: