MEDICARE: EMILIO DEL VALLE, M.D., P.A.

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	:	1518088517
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMILIO DEL VALLE, M.D., P.A.

Provider Business Mailing Address
First Line	:	1860 BOY SCOUT DR STE 201
Second Line	:
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 STE 103
Second Line	:
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	:	PRESIDENT
Name	:	DR. EMILIO DEL VALLE
Credential	:	M.D.
Telephone Number	:	239-277-7666

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	04/19/2018

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