Provider Demographics
NPI:1669423141
Name:DELUCIA, EUGENE R III (DO)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:R
Last Name:DELUCIA
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4543 S MANHATTAN AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33611-2330
Mailing Address - Country:US
Mailing Address - Phone:813-837-2461
Mailing Address - Fax:813-835-1731
Practice Address - Street 1:4543 S MANHATTAN AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33611-2330
Practice Address - Country:US
Practice Address - Phone:813-837-2461
Practice Address - Fax:813-835-1731
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS3780207Q00000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL057019200Medicaid
FLE34831Medicare UPIN
FL057019200Medicaid