Healthcare Provider Details

I. General information

NPI: 1164676938
Provider Name (Legal Business Name): JOHN ROBERT CARLUCCI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2008
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 FORUM PL STE 101
WEST PALM BEACH FL
33401-8102
US

IV. Provider business mailing address

1601 FORUM PL STE 101
WEST PALM BEACH FL
33401-8102
US

V. Phone/Fax

Practice location:
  • Phone: 561-455-1355
  • Fax:
Mailing address:
  • Phone: 561-455-1355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number165509
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number247733
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: