Healthcare Provider Details

I. General information

NPI: 1982674370
Provider Name (Legal Business Name): FRANKLIN O DE LA CRUZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 06/08/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S 5TH ST SUITE #9
BARDSTOWN KY
40004-1142
US

IV. Provider business mailing address

PO BOX 936
LONDON KY
40743-0936
US

V. Phone/Fax

Practice location:
  • Phone: 502-348-7755
  • Fax: 502-349-0815
Mailing address:
  • Phone: 502-348-7755
  • Fax: 606-330-7825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number29164
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number29164
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: