Provider Demographics
NPI:1700833902
Name:CRUZ, MANUEL W (MD)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:W
Last Name:CRUZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8150 N CENTRAL EXPY
Mailing Address - Street 2:M1001
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-1815
Mailing Address - Country:US
Mailing Address - Phone:214-221-0022
Mailing Address - Fax:214-691-8292
Practice Address - Street 1:8150 N CENTRAL EXPY
Practice Address - Street 2:M1001
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-1815
Practice Address - Country:US
Practice Address - Phone:214-221-0022
Practice Address - Fax:214-691-8292
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK8101207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
060054456OtherRR MCARE
TX106141801Medicaid
TX4193049OtherBLULINK
TX106141802Medicaid