Healthcare Provider Details

I. General information

NPI: 1124081237
Provider Name (Legal Business Name): EDGARDO CRUZ-MARTINEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 12/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 SE MAGNOLIA EXT SUITE 205
OCALA FL
34471-4463
US

IV. Provider business mailing address

1500 SE MAGNOLIA EXT SUITE 205
OCALA FL
34471-4463
US

V. Phone/Fax

Practice location:
  • Phone: 352-629-1800
  • Fax: 352-629-1888
Mailing address:
  • Phone: 352-629-1800
  • Fax: 352-629-1888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME78169
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME78169
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: