# DELTA CORPS DIAGNOSTICS LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417769894
- **Authorized official:** DR. GERALD MASTAW JR. MD (CEO)
- **Authorized official phone:** (734) 389-5832

## Contact information

- **Practice address:** 495 GRAND BLVD STE 206, MIRAMAR BEACH, FL 32550-1897
- **Practice address phone:** (734) 389-5832
- **Practice address fax:** (813) 489-9562
- **Mailing address:** 495 GRAND BLVD STE 206, MIRAMAR BEACH, FL 32550-1897
- **Mailing address phone:** (734) 389-5832

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | NULL | Yes |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/23/2025
- **Last updated:** 01/23/2025