MEDICARE: LOUIS A DELIONBACK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	3729	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1194702472	OTHER		NPI
2	11040113	OTHER		CAQH

General Provider Information

NPI Number	:	1194702472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOUIS A DELIONBACK MD

Provider Business Mailing Address
First Line	:	PO BOX 3046
Second Line	:
City	:	MALVERN
State	:	PA
Zip	:	19355-0746
Country	:	US
Telephone Number	:	775-352-3080
Fax Number	:

Provider Business Practice Location Address
First Line	:	5975 S LOS ALTOS PKWY
Second Line	:	SUITE 100
City	:	SPARKS
State	:	NV
Zip	:	89436-7699
Country	:	US
Telephone Number	:	775-352-3080
Fax Number	:	775-327-4121

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	05/08/2018

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Directions to “ LOUIS A DELIONBACK MD” Practice Location

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