Provider Demographics
NPI:1417969478
Name:DELUCA, JOSEPH A (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:A
Last Name:DELUCA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 W GROVE ST STE 202
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-4425
Mailing Address - Country:US
Mailing Address - Phone:870-234-7676
Mailing Address - Fax:870-562-2560
Practice Address - Street 1:620 W GROVE ST STE 202
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-4425
Practice Address - Country:US
Practice Address - Phone:870-234-7676
Practice Address - Fax:870-562-2560
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE4974207R00000X
ARE-4974207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000268009402OtherUNITED HEALTH CARE
P00340667OtherMEDICARE RAILROAD
06080014300OtherQUALCHOICE
AR1622343001Medicaid
7906846OtherAETNA
AR771084601OtherBREASTCARE
I61417Medicare UPIN
AR1622343001Medicaid