Provider Demographics
NPI:1336320787
Name:CRUZ-GOMEZ, GLOYDIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:GLOYDIAN
Middle Name:
Last Name:CRUZ-GOMEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:GLOYDIAN
Other - Middle Name:GOMEZ
Other - Last Name:CRUZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2835 ALT 19
Mailing Address - Street 2:SUITE B
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-1926
Mailing Address - Country:US
Mailing Address - Phone:727-748-4742
Mailing Address - Fax:727-748-4739
Practice Address - Street 1:2835 ALT 19
Practice Address - Street 2:SUITE B
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-1926
Practice Address - Country:US
Practice Address - Phone:727-748-4742
Practice Address - Fax:727-748-4739
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-14
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME110430208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14F22OtherFLORIDA BLUE
FL7722166OtherCIGNA
FL2338967OtherGHI
FL14F22OtherFLORIDA BLUE