Provider Demographics
NPI:1700877362
Name:DALUGA, PAUL L JR (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:L
Last Name:DALUGA
Suffix:JR
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 1:1020 LAKE SUMTER LNDG
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-2699
Mailing Address - Country:US
Mailing Address - Phone:352-674-8905
Mailing Address - Fax:352-674-8905
Practice Address - Street 1:8877 SE 165TH MULBERRY LANE
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-1039
Practice Address - Country:US
Practice Address - Phone:352-674-1750
Practice Address - Fax:352-674-8950
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01032765207Q00000X
FLME115501207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN080063474OtherRR MEDICARE
IN100124830Medicaid
IN080148327OtherRR MEDICARE
FLHQ432ZOtherPTAN
IN080148327Medicare PIN
FLHQ432ZOtherPTAN
IN100124830Medicaid
IN941090CC5Medicare PIN
IN080148327OtherRR MEDICARE
IN080063474Medicare PIN
IN130910BMedicare PIN
IN854700QQMedicare PIN