Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | ME076350 | FL |
NPI | 1003835604 |
---|---|
Provider Name | Dr. Richard Anthony Delucia JR. |
First Address | Jupiter, FL 33458-4810 |
Second Address | Jupiter, FL 33458-4810 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 17/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
255385600 | (05) | FL |
43902 | BCBS (01) | FL |
G73169 | (02) | FL |