Provider Demographics
NPI:1295729739
Name:DELUCA, ROBERT CHARLES (DO)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CHARLES
Last Name:DELUCA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W PLUMMER ST
Mailing Address - Street 2:
Mailing Address - City:EASTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:76448-2629
Mailing Address - Country:US
Mailing Address - Phone:254-629-3393
Mailing Address - Fax:254-629-3392
Practice Address - Street 1:500 W PLUMMER ST
Practice Address - Street 2:
Practice Address - City:EASTLAND
Practice Address - State:TX
Practice Address - Zip Code:76448-2629
Practice Address - Country:US
Practice Address - Phone:254-629-3393
Practice Address - Fax:254-629-3392
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2009-07-06
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-03-30
Provider Licenses
StateLicense IDTaxonomies
TXG8076207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00GR47OtherBLUE CROSS
TX110572801Medicaid
TX8B7771Medicare PIN
TXD75126Medicare UPIN