Provider Demographics
NPI:1932696747
Name:CRUZ, JARED (DO)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:CRUZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MEDICAL CITY FORT WORTH
Mailing Address - Street 2:900 8TH AVENUE
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76103-3902
Mailing Address - Country:US
Mailing Address - Phone:817-336-2100
Mailing Address - Fax:
Practice Address - Street 1:MEDICAL CITY FORT WORTH
Practice Address - Street 2:900 8TH AVENUE
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76103-3902
Practice Address - Country:US
Practice Address - Phone:817-336-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-17
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS20218207Q00000X
MI5101027326207Q00000X
TXU6220207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine