MEDICARE: EUSEBIO D MARTIN DELGADO

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	2085R0202X	Diagnostic Radiology Physician	144688	TX

General Provider Information

NPI Number	:	1821745076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUSEBIO D MARTIN DELGADO

Provider Business Mailing Address
First Line	:	8412 MINEOLA DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79925-4922
Country	:	US
Telephone Number	:	915-490-4737
Fax Number	:

Provider Business Practice Location Address
First Line	:	8412 MINEOLA DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79925-4922
Country	:	US
Telephone Number	:	915-490-4737
Fax Number	:

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

Provider Enumeration Date	:	03/08/2022
Last Update Date	:	03/08/2022

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