MEDICARE: VIANKA LEGRA DELGADO 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	207R00000X	Internal Medicine Physician	036117947	IL
2	207R00000X	Internal Medicine Physician	ME101871	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407044480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIANKA LEGRA DELGADO MD

Provider Business Mailing Address
First Line	:	3218 W HORATIO ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-3028
Country	:	US
Telephone Number	:	813-600-9981
Fax Number	:	866-441-4463

Provider Business Practice Location Address
First Line	:	7756 PALM RIVER RD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-4215
Country	:	US
Telephone Number	:	813-626-0066
Fax Number	:	866-441-4463

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

Provider Enumeration Date	:	10/04/2007
Last Update Date	:	03/20/2017

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