Provider Demographics
NPI:1366503203
Name:JUPITER FAMILYHEALTHCARE,PA
Entity Type:Organization
Organization Name:JUPITER FAMILYHEALTHCARE,PA
Other - Org Name:JUPITER FAMILY HEALTHCARE,PA
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:DELUCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-776-5252
Mailing Address - Street 1:4600 MILITARY TRL
Mailing Address - Street 2:#115
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-4810
Mailing Address - Country:US
Mailing Address - Phone:561-776-5252
Mailing Address - Fax:561-776-5255
Practice Address - Street 1:4600 MILITARY TRL
Practice Address - Street 2:#115
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-4810
Practice Address - Country:US
Practice Address - Phone:561-776-5252
Practice Address - Fax:561-776-5255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0076350207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty