MEDICARE: DR. HUMBERTO CRUZ JR. D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	OS6875	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1891787991	OTHER	FL	GROUP NPI ID

General Provider Information

NPI Number	:	1477678837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HUMBERTO CRUZ JR. D.O.

Provider Business Mailing Address
First Line	:	7200 CURRY FORD RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32822-5806
Country	:	US
Telephone Number	:	407-658-0100
Fax Number	:	407-658-5702

Provider Business Practice Location Address
First Line	:	7200 CURRY FORD RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32822-5806
Country	:	US
Telephone Number	:	407-658-0100
Fax Number	:	407-658-5702

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	07/09/2007

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