Provider Demographics
NPI:1326126525
Name:IDXPERT, P.C.
Entity Type:Organization
Organization Name:IDXPERT, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ORLANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-729-1350
Mailing Address - Street 1:URB BELLAS LOMAS
Mailing Address - Street 2:#907 CALLE CRUZ
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00682
Mailing Address - Country:US
Mailing Address - Phone:314-729-1350
Mailing Address - Fax:314-222-0614
Practice Address - Street 1:10004 KENNERLY RD
Practice Address - Street 2:SUITE 259B
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2141
Practice Address - Country:US
Practice Address - Phone:314-729-1350
Practice Address - Fax:314-222-0614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2056665OtherAETNA HMO
MO9200025OtherUNITED HEALTHCARE
MO1555912OtherCIGNA
MO290274OtherGHP
MO2220OtherHEALTHCARE USA
MO110831OtherBLUE CROSS-BLUE SHIELD
MO11563OtherESSENCE
MO290274OtherHEALTHLINK
MO5056433805Medicaid
MO5859116OtherAETNA
MO290274OtherHEALTHLINK
MO290274OtherGHP