Provider Demographics
NPI:1255307641
Name:LOCICERO, KARON R (MD)
Entity type:Individual
Prefix:
First Name:KARON
Middle Name:R
Last Name:LOCICERO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2605 W SWANN AVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609
Mailing Address - Country:US
Mailing Address - Phone:813-876-7073
Mailing Address - Fax:813-879-3737
Practice Address - Street 1:2605 W SWANN AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609
Practice Address - Country:US
Practice Address - Phone:813-876-7073
Practice Address - Fax:813-879-3737
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0047336207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL048214500Medicaid
04859YMedicare PIN
FL04859YMedicare ID - Type Unspecified
FLD84819Medicare UPIN