Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | 1349 | CO |
Y | 152W00000X | Optometrist | 3775TG | TX |
NPI | 1003933573 |
---|---|
Provider Name | Dr. Mark Christopher Delgado |
First Address | San Antonio, TX 78250-6806 |
Second Address | San Antonio, TX 78250-6806 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G000E96L2 | (05) | TX |
T12979 | (02) | TX |