Provider Demographics
NPI:1376740308
Name:DELGADO, BRYANT LUIS (MD)
Entity type:Individual
Prefix:DR
First Name:BRYANT
Middle Name:LUIS
Last Name:DELGADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 E KEN PRATT BLVD FL 3
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80504-5311
Mailing Address - Country:US
Mailing Address - Phone:720-718-3900
Mailing Address - Fax:720-718-0999
Practice Address - Street 1:1750 E KEN PRATT BLVD FL 3
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80504-5311
Practice Address - Country:US
Practice Address - Phone:720-718-3900
Practice Address - Fax:720-718-0999
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME107236207RP1001X
CO51325207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002481400Medicaid
FLDJ018ZMedicare PIN