Provider Demographics
NPI:1518042761
Name:CRUZ, HALBERTO G (MD)
Entity Type:Individual
Prefix:DR
First Name:HALBERTO
Middle Name:G
Last Name:CRUZ
Suffix:
Gender:M
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:PO BOX 671
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-0671
Mailing Address - Country:US
Mailing Address - Phone:304-645-4043
Mailing Address - Fax:304-645-4713
Practice Address - Street 1:400 FAIRVIEW HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651-9308
Practice Address - Country:US
Practice Address - Phone:304-645-4043
Practice Address - Fax:304-645-4713
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV119942085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
55073865301OtherCHAMPUS
WV0123032000Medicaid
WV288546OtherMAMSI
WV0123032000Medicaid
WV0636088Medicare ID - Type Unspecified