Healthcare Provider Details

I. General information

NPI: 1578557468
Provider Name (Legal Business Name): JOSE G DELGADO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 09/23/2022
Certification Date: 09/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 W LOUISIANA AVE
MIDLAND TX
79701-3248
US

IV. Provider business mailing address

4214 ANDREWS HWY STE 240
MIDLAND TX
79703-4817
US

V. Phone/Fax

Practice location:
  • Phone: 432-221-3100
  • Fax: 432-221-3121
Mailing address:
  • Phone: 432-221-5971
  • Fax: 432-221-5981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberL8035
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: