Healthcare Provider Details

I. General information

NPI: 1326126525
Provider Name (Legal Business Name): IDXPERT, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 01/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10004 KENNERLY RD SUITE 259B
SAINT LOUIS MO
63128-2141
US

IV. Provider business mailing address

URB BELLAS LOMAS #907 CALLE CRUZ
MAYAGUEZ PR
00682
US

V. Phone/Fax

Practice location:
  • Phone: 314-729-1350
  • Fax: 314-222-0614
Mailing address:
  • Phone: 314-729-1350
  • Fax: 314-222-0614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. ORLANDO CRUZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 314-729-1350