Provider Demographics
NPI:1609163153
Name:CRUZ, JAIRO B JR (DPM)
Entity Type:Individual
Prefix:DR
First Name:JAIRO
Middle Name:B
Last Name:CRUZ
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:38192 MEDICAL CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33540-1380
Mailing Address - Country:US
Mailing Address - Phone:813-782-3233
Mailing Address - Fax:813-502-5904
Practice Address - Street 1:38192 MEDICAL CENTER AVE
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33540-1380
Practice Address - Country:US
Practice Address - Phone:813-782-3233
Practice Address - Fax:813-502-5904
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3671213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL114053700Medicaid
FLPO2398421OtherRR MCARE INDIVIDUAL
FLPO3671OtherMEDICAL LICENSE
FL1326058249OtherGROUP NPI
FL14X4TOtherBCBS INDIV ID
FLL2158OtherMEDICARE PTAN IND
FLL2158OtherMEDICARE INDIVDUAL
FL5157370001OtherNSC DME PTAN
FL14X4TOtherBCBS INDIV ID
FLK8186OtherMEDICARE GROUP PTAN