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NPI Code Detail

MEDICARE: DR. LAURIE J. DE LUCA MD

MEDICARE: DR. LAURIE J. DE LUCA MD
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
1207P00000XEmergency Medicine PhysicianME94019FL
2207PE0005XUndersea and Hyperbaric Medicine (Emergency Medicine) PhysicianME94019FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P01037262OTHERFLRAILROAD MEDICARE ATTACHED TO GRP# DQ1103

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
129406OTHERFLBCBS OF FLORIDA
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1740235738
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LAURIE J. DE LUCA MD
Provider Business Mailing Address
First Line : PO BOX 25595
Second Line :
City : TAMPA
State : FL
Zip : 33622-5595
Country : US
Telephone Number : 727-823-2188
Fax Number : 727-828-0723
Provider Business Practice Location Address
First Line : 7171 N DALE MABRY HWY
Second Line : STE 404
City : TAMPA
State : FL
Zip : 33614-2665
Country : US
Telephone Number : 813-932-1510
Fax Number : 813-238-4378
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2006
Last Update Date : 06/27/2012

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