Healthcare Provider Details

I. General information

NPI: 1497816169
Provider Name (Legal Business Name): GREGORY SCOTT DELANGE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 04/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2865 PGA BLVD
PALM BEACH GARDENS FL
33410-2910
US

IV. Provider business mailing address

244 W RIVERSIDE DR
TEQUESTA FL
33469-2948
US

V. Phone/Fax

Practice location:
  • Phone: 561-776-9555
  • Fax: 561-776-8495
Mailing address:
  • Phone: 561-746-4466
  • Fax: 561-776-8495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME 72823
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: