Provider Demographics
NPI:1700809480
Name:CRUZ, CARLOS P (M D)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:P
Last Name:CRUZ
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3322 COLORADO BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-6888
Mailing Address - Country:US
Mailing Address - Phone:940-387-7588
Mailing Address - Fax:940-566-0881
Practice Address - Street 1:3322 COLORADO BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-6888
Practice Address - Country:US
Practice Address - Phone:940-387-7588
Practice Address - Fax:940-566-0881
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL80242086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K7640OtherBLUE CROSS OF TEXAS
TX164196101Medicaid
TX8K7640OtherBLUE CROSS OF TEXAS
TX164196101Medicaid
H35825Medicare UPIN