Provider Demographics
NPI:1609952092
Name:CRUZ-GONZALEZ, EDGAR V M (MD)
Entity Type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:V M
Last Name:CRUZ-GONZALEZ
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 2975
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-2975
Mailing Address - Country:US
Mailing Address - Phone:956-362-8170
Mailing Address - Fax:956-362-8168
Practice Address - Street 1:1100 E DOVE AVE STE 300
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-4672
Practice Address - Country:US
Practice Address - Phone:956-362-8170
Practice Address - Fax:956-362-8168
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4033208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX175076201Medicaid
TX8AJ767OtherBCBS
TX100726207Medicaid
TX100726205Medicaid
TX100726206Medicaid
TXP00278614OtherRAILROAD
TXG70282Medicare UPIN
TX8J4785Medicare PIN
TX8AJ767OtherBCBS
TXP00278614OtherRAILROAD
TX100726205Medicaid
TX175076201Medicaid