Provider Demographics
NPI:1134430374
Name:CRUZ, DAN (MD, DABFM)
Entity type:Individual
Prefix:DR
First Name:DAN
Middle Name:
Last Name:CRUZ
Suffix:
Gender:M
Credentials:MD, DABFM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13790 BRIDGEWATER CROSSINGS BLVD
Mailing Address - Street 2:STE 1080
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-5447
Mailing Address - Country:US
Mailing Address - Phone:321-987-4448
Mailing Address - Fax:347-719-4039
Practice Address - Street 1:13790 BRIDGEWATER CROSSINGS BLVD
Practice Address - Street 2:STE 1080
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-5447
Practice Address - Country:US
Practice Address - Phone:321-987-4448
Practice Address - Fax:347-719-4039
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-22
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 123606207Q00000X, 207Q00000X, 207QA0401X
MA255714207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1100996808Medicaid
FL606703Medicaid