Healthcare Provider Details

I. General information

NPI: 1194936039
Provider Name (Legal Business Name): ADRIANNE M DELA PAZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 10/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 POPLAR STREET
TERRE HAUTE IN
47807-4209
US

IV. Provider business mailing address

221 SO. 6TH STREET
TERRE HAUTE IN
47807-4214
US

V. Phone/Fax

Practice location:
  • Phone: 812-242-3700
  • Fax: 812-234-3565
Mailing address:
  • Phone: 812-242-3700
  • Fax: 812-234-3565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number01067357A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: