MEDICARE: DR. ALEX RAMON TAVERAS-CRUZ M.D.

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	208D00000X	General Practice Physician	15423	PR

General Provider Information

NPI Number	:	1780645903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEX RAMON TAVERAS-CRUZ M.D.

Provider Business Mailing Address
First Line	:	2460 OLD MOULTRIE RD STE 2
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32086-4198
Country	:	US
Telephone Number	:	904-293-0299
Fax Number	:	904-797-7417

Provider Business Practice Location Address
First Line	:	264A PALM COAST PKWY NE
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32137-8217
Country	:	US
Telephone Number	:	386-446-5505
Fax Number	:	386-446-5077

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

Provider Enumeration Date	:	03/29/2006
Last Update Date	:	10/02/2019

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