Provider Demographics
NPI:1558691527
Name:PEDRO A. CRUZ ,M.D.,P.A.
Entity Type:Organization
Organization Name:PEDRO A. CRUZ ,M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:A
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-946-9732
Mailing Address - Street 1:737 N BISHOP AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-4304
Mailing Address - Country:US
Mailing Address - Phone:214-946-9732
Mailing Address - Fax:214-946-9752
Practice Address - Street 1:737 N BISHOP AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-4304
Practice Address - Country:US
Practice Address - Phone:214-946-9732
Practice Address - Fax:214-946-9752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-13
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE5721207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX031889101Medicaid
TX0A5761Medicare PIN
TX031889101Medicaid