Provider Demographics
NPI:1962411892
Name:DELAGARZA, JERALD ALBERT (MD)
Entity type:Individual
Prefix:
First Name:JERALD
Middle Name:ALBERT
Last Name:DELAGARZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:288 S RIDGECREST AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RUTHERFORDTON
Mailing Address - State:NC
Mailing Address - Zip Code:28139-2838
Mailing Address - Country:US
Mailing Address - Phone:828-287-9325
Mailing Address - Fax:828-287-9709
Practice Address - Street 1:288 S RIDGECREST AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:RUTHERFORDTON
Practice Address - State:NC
Practice Address - Zip Code:28139-2838
Practice Address - Country:US
Practice Address - Phone:828-287-9325
Practice Address - Fax:828-287-9709
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC200200513208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891323HMedicaid
NC1323HOtherBCBS
NC891323HMedicaid