Individual
DR. LAURIE J. DE LUCA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
7171 N DALE MABRY HWY, STE 404, TAMPA, FL 33614-2665
(813) 932-1510
(813) 238-4378
Mailing address
PO BOX 25595, TAMPA, FL 33622-5595
(727) 823-2188
(727) 828-0723
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
ME94019
FL
207PE0005X
Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
Primary
ME94019
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
273731100
—
FL
01
—
29406
BCBS OF FLORIDA
FL
01
—
P01037262
RAILROAD MEDICARE ATTACHED TO GRP# DQ1103
FL
Enumeration date
05/24/2006
Last updated
06/27/2012
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