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Individual

JONETHAN P DELAUGHTER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.O.

Contact information

Practice address
1906 BELLEVIEW AVE SE, ROANOKE, VA 24014-1838
(540) 266-6331
Mailing address
2900 LAMB CIR, CHRISTIANSBURG, VA 24073-6344
(540) 731-2866

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
0102203459
VA
207P00000X
Emergency Medicine Physician
N5647
TX
207P00000X
Emergency Medicine Physician
OT011592
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1457518839
BCBS
01
8CK313
BCBS TX
TX
Enumeration date
05/22/2008
Last updated
11/13/2013
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