Healthcare Provider Details

I. General information

NPI: 1174899363
Provider Name (Legal Business Name): GARY LOFRANCO DEQUINA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2012
Last Update Date: 08/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TAMPA GENERAL CIR STE A327
TAMPA FL
33606
US

IV. Provider business mailing address

7008 N CAMERON AVE
TAMPA FL
33614-3139
US

V. Phone/Fax

Practice location:
  • Phone: 813-844-4434
  • Fax:
Mailing address:
  • Phone: 201-686-1739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number129107
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME133456
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: