Provider Demographics
NPI:1275681983
Name:ERWIN A. CRUZ, MD, PA
Entity Type:Organization
Organization Name:ERWIN A. CRUZ, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:ERWIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-503-2780
Mailing Address - Street 1:PO BOX 1313
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-1313
Mailing Address - Country:US
Mailing Address - Phone:972-991-9950
Mailing Address - Fax:972-991-4026
Practice Address - Street 1:12800 PRESTON RD
Practice Address - Street 2:STE. 101
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-1365
Practice Address - Country:US
Practice Address - Phone:972-503-2783
Practice Address - Fax:972-503-2783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5860174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE68246Medicare UPIN
TX00220VMedicare ID - Type Unspecified