Provider Demographics
NPI:1235391509
Name:EDUARDO ERCIA MD PA
Entity Type:Organization
Organization Name:EDUARDO ERCIA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:ERCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-886-0713
Mailing Address - Street 1:6301 MEMORIAL HWY
Mailing Address - Street 2:SUITE 204
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-4573
Mailing Address - Country:US
Mailing Address - Phone:813-886-0713
Mailing Address - Fax:813-881-1848
Practice Address - Street 1:6301 MEMORIAL HWY
Practice Address - Street 2:SUITE 204
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-4573
Practice Address - Country:US
Practice Address - Phone:813-886-0713
Practice Address - Fax:813-881-1848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-27
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL051043200Medicaid
FL051043200Medicaid
FLD21913Medicare UPIN