Provider Demographics
NPI:1043499593
Name:EUGENE R.DELUCIA III,D.O.,P.A.
Entity Type:Organization
Organization Name:EUGENE R.DELUCIA III,D.O.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:R
Authorized Official - Last Name:DELUCIA
Authorized Official - Suffix:III
Authorized Official - Credentials:DO
Authorized Official - Phone:813-837-2461
Mailing Address - Street 1:4543 S MANHATTAN AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33611
Mailing Address - Country:US
Mailing Address - Phone:813-837-2461
Mailing Address - Fax:813-835-1731
Practice Address - Street 1:4543 S MANHATTAN AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33611-2330
Practice Address - Country:US
Practice Address - Phone:813-837-2461
Practice Address - Fax:813-835-1731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0003780207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty