Provider Demographics
NPI:1437377611
Name:EDGAR CRUZ MD PA
Entity Type:Organization
Organization Name:EDGAR CRUZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:V
Authorized Official - Last Name:CRUZ GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-687-7151
Mailing Address - Street 1:1801 S 5TH ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-2927
Mailing Address - Country:US
Mailing Address - Phone:956-687-7151
Mailing Address - Fax:956-213-8176
Practice Address - Street 1:1801 S 5TH ST
Practice Address - Street 2:SUITE 120
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-2927
Practice Address - Country:US
Practice Address - Phone:956-687-7151
Practice Address - Fax:956-213-8176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4033208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDE2116OtherRAILROAD
TX0052QPOtherBCBS
TX175076201Medicaid
TX0052QPOtherBCBS
TX175076201Medicaid