Provider Demographics
NPI:1679583751
Name:CUA, WILLIAM LAURENTE (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:LAURENTE
Last Name:CUA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 RANCH RD
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34688-9027
Mailing Address - Country:US
Mailing Address - Phone:727-848-2444
Mailing Address - Fax:727-817-1577
Practice Address - Street 1:555 RANCH RD
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34688-9027
Practice Address - Country:US
Practice Address - Phone:727-848-2444
Practice Address - Fax:727-817-1577
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME630652084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
F84825Medicare UPIN
FLF84825Medicare UPIN
25483Medicare PIN