MEDICARE: EMILIO DELVALLE M.D.

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	208000000X	Pediatrics Physician	ME55848	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	:	1477551497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILIO DELVALLE M.D.

Provider Business Mailing Address
First Line	:	1860 BOY SCOUT DR
Second Line	:	STE 201
City	:	FORT MYERS
State	:	FL
Zip	:	33907-2119
Country	:	US
Telephone Number	:	239-215-1180
Fax Number	:	239-215-1179

Provider Business Practice Location Address
First Line	:	6300 CORPORATE CT
Second Line	:	STE 103
City	:	FORT MYERS
State	:	FL
Zip	:	33919-3513
Country	:	US
Telephone Number	:	239-277-7666
Fax Number	:	239-277-1064

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

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	04/24/2018

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