MEDICARE: FREDY E DELACRUZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	ME39547	FL

General Provider Information

NPI Number	:	1316928781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FREDY E DELACRUZ MD

Provider Business Mailing Address
First Line	:	6100 MINTON RD NW
Second Line	:	STE 101
City	:	PALM BAY
State	:	FL
Zip	:	32907-1975
Country	:	US
Telephone Number	:	321-722-1984
Fax Number	:	321-722-0028

Provider Business Practice Location Address
First Line	:	6100 MINTON RD NW
Second Line	:	STE 101
City	:	PALM BAY
State	:	FL
Zip	:	32907-1975
Country	:	US
Telephone Number	:	321-722-1984
Fax Number	:	321-722-0028

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	07/08/2007

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