Provider Demographics
NPI:1982674370
Name:DE LA CRUZ, FRANKLIN O (MD)
Entity Type:Individual
Prefix:DR
First Name:FRANKLIN
Middle Name:O
Last Name:DE LA 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 936
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-0936
Mailing Address - Country:US
Mailing Address - Phone:502-348-7755
Mailing Address - Fax:606-330-7825
Practice Address - Street 1:201 S 5TH ST
Practice Address - Street 2:SUITE #9
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-1142
Practice Address - Country:US
Practice Address - Phone:502-348-7755
Practice Address - Fax:502-349-0815
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY29164174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1052134OtherPASSPORT
KY29164OtherSTATE LICENSE
KY64291644Medicaid
KY0619902Medicare ID - Type Unspecified
KY1052134OtherPASSPORT