MEDICARE: DR. EUGENE R DELUCIA III D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	OS3780	FL
2	208100000X	Physical Medicine & Rehabilitation Physician	OS3780	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669423141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EUGENE R DELUCIA III D.O.

Provider Business Mailing Address
First Line	:	4543 S MANHATTAN AVE
Second Line	:	SUITE 102
City	:	TAMPA
State	:	FL
Zip	:	33611-2330
Country	:	US
Telephone Number	:	813-837-2461
Fax Number	:	813-835-1731

Provider Business Practice Location Address
First Line	:	4543 S MANHATTAN AVE
Second Line	:	SUITE 102
City	:	TAMPA
State	:	FL
Zip	:	33611-2330
Country	:	US
Telephone Number	:	813-837-2461
Fax Number	:	813-835-1731

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	01/02/2020

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Directions to “ DR. EUGENE R DELUCIA III D.O.” Practice Location

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