Provider Demographics
NPI:1326239161
Name:EDGARDO CRUZ-MARTINEZ M.D., P.A.
Entity Type:Organization
Organization Name:EDGARDO CRUZ-MARTINEZ M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:EDGARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ-MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-861-5225
Mailing Address - Street 1:4600 SW 46TH CT STE 120
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-5785
Mailing Address - Country:US
Mailing Address - Phone:352-861-5225
Mailing Address - Fax:352-861-5226
Practice Address - Street 1:4600 SW 46TH CT STE 120
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-5785
Practice Address - Country:US
Practice Address - Phone:352-861-5225
Practice Address - Fax:352-861-5226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78169174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274278OtherAVMED
FL35563OtherBCBS
FL3016994OtherCIGNA
FL35563OtherBCBS
FLH17087Medicare UPIN