Provider Demographics
NPI:1952557183
Name:JACOBO A CRUZ MD PA
Entity type:Organization
Organization Name:JACOBO A CRUZ MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOBO
Authorized Official - Middle Name:A
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-484-7774
Mailing Address - Street 1:4400 BAYOU BLVD
Mailing Address - Street 2:SUITE 51
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2673
Mailing Address - Country:US
Mailing Address - Phone:850-484-7774
Mailing Address - Fax:850-484-8874
Practice Address - Street 1:4400 BAYOU BLVD
Practice Address - Street 2:SUITE 51
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2673
Practice Address - Country:US
Practice Address - Phone:850-484-7774
Practice Address - Fax:850-484-8874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-07
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME489742084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL048405900Medicaid
FL1043301518OtherNPI
FL02327ZMedicare PIN
FL1043301518OtherNPI