Individual
ERIC DEAN CASTELLUCCI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3001 W DR MARTIN LUTHER KING JR BLVD, TAMPA, FL 33607-6307
(813) 870-4000
Mailing address
PO BOX 10030, DAYTONA BEACH, FL 32120-0030
(386) 274-7800
(386) 274-7801
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
ME60245
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
055708100
—
FL
01
—
12903
BLUE CROSS OF FLORIDA
FL
01
—
221516
AMERIGROUP
FL
Enumeration date
06/12/2006
Last updated
04/29/2015
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