Healthcare Provider Details

I. General information

NPI: 1477671238
Provider Name (Legal Business Name): EDUARDO VARGAS CRUZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 01/27/2026
Certification Date: 01/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1138 N GERMANTOWN PKWY # 101-377
CORDOVA TN
38016-5872
US

IV. Provider business mailing address

PO BOX 342345
MEMPHIS TN
38184-2345
US

V. Phone/Fax

Practice location:
  • Phone: 901-373-4311
  • Fax: 901-328-1888
Mailing address:
  • Phone: 901-373-4311
  • Fax: 901-373-4262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberMD13794
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: