Provider Demographics
NPI:1952308231
Name:CRUZ, ERWIN A (MD)
Entity Type:Individual
Prefix:
First Name:ERWIN
Middle Name:A
Last Name:CRUZ
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 1313
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-1313
Mailing Address - Country:US
Mailing Address - Phone:972-991-9950
Mailing Address - Fax:972-991-9548
Practice Address - Street 1:12800 PRESTON RD
Practice Address - Street 2:STE 101
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-1366
Practice Address - Country:US
Practice Address - Phone:972-503-2780
Practice Address - Fax:972-503-2783
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5860174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A7237Medicare ID - Type Unspecified
TXE68246Medicare UPIN