Healthcare Provider Details

I. General information

NPI: 1154374494
Provider Name (Legal Business Name): FERNANDO CRUZADO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5994 S HOSPITAL DR
GLOBE AZ
85501-9462
US

IV. Provider business mailing address

PO BOX 1918
CLAYPOOL AZ
85532-1918
US

V. Phone/Fax

Practice location:
  • Phone: 928-425-7108
  • Fax: 928-425-7925
Mailing address:
  • Phone: 928-425-0912
  • Fax: 928-425-0914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number30961
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: