Healthcare Provider Details

I. General information

NPI: 1679583751
Provider Name (Legal Business Name): WILLIAM LAURENTE CUA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 04/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 RANCH RD
TARPON SPRINGS FL
34688-9027
US

IV. Provider business mailing address

555 RANCH RD
TARPON SPRINGS FL
34688-9027
US

V. Phone/Fax

Practice location:
  • Phone: 727-848-2444
  • Fax: 727-817-1577
Mailing address:
  • Phone: 727-848-2444
  • Fax: 727-817-1577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME63065
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: