Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | MD20951 | OR |
NPI | 1184643249 |
---|---|
Provider Name | William J Delgado |
First Address | Bend, OR 97701-8738 |
Second Address | Bend, OR 97701-6904 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 10/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
133961 | (05) | OR |
H00563 | (02) | OR |