Provider Demographics
NPI:1205216751
Name:CRUZ, FERNANDO MICHAEL (DPM)
Entity Type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:MICHAEL
Last Name:CRUZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3229 W 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110-4817
Mailing Address - Country:US
Mailing Address - Phone:903-872-9910
Mailing Address - Fax:855-874-7393
Practice Address - Street 1:3229 W 7TH AVE
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110
Practice Address - Country:US
Practice Address - Phone:903-872-9910
Practice Address - Fax:855-874-7393
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-30
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2325213ES0103X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery