Provider Demographics
NPI:1043429467
Name:FRANCIS A DERITO M.D.
Entity Type:Organization
Organization Name:FRANCIS A DERITO M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:DERITO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-717-9810
Mailing Address - Street 1:303 N PLANT AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-4730
Mailing Address - Country:US
Mailing Address - Phone:813-717-9810
Mailing Address - Fax:813-717-9615
Practice Address - Street 1:303 N PLANT AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-4730
Practice Address - Country:US
Practice Address - Phone:813-717-9810
Practice Address - Fax:813-717-9615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0052993207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD21052Medicare UPIN