Provider Demographics
NPI:1326079658
Name:CRUZ, PAMELA U (MD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:U
Last Name:CRUZ
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 1:751 HEBRON PKWY STE 150
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-5070
Mailing Address - Country:US
Mailing Address - Phone:972-316-0450
Mailing Address - Fax:214-488-2762
Practice Address - Street 1:751 HEBRON PKWY STE 150
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-5070
Practice Address - Country:US
Practice Address - Phone:972-316-0450
Practice Address - Fax:214-488-2762
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2203207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX153577501Medicaid
TX153577502Medicaid