Provider Demographics
NPI:1023014958
Name:CRUZ-GONZALEZ, IRMA (MD)
Entity Type:Individual
Prefix:
First Name:IRMA
Middle Name:
Last Name:CRUZ-GONZALEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 MORRILL PL STE 2
Mailing Address - Street 2:
Mailing Address - City:AMESBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01913-3530
Mailing Address - Country:US
Mailing Address - Phone:978-834-8074
Mailing Address - Fax:
Practice Address - Street 1:255 LOW ST STE 201
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-3596
Practice Address - Country:US
Practice Address - Phone:978-465-4622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86098174400000X
NH19793207RG0100X
ORMD193907207RG0100X
MA281987207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110160860AMedicaid
FL269186800Medicaid
FL269186800Medicaid