MEDICARE: VICTOR T CRUZ 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	2085R0202X	Diagnostic Radiology Physician	TEMPORARY	TX

General Provider Information

NPI Number	:	1710957584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTOR T CRUZ MD

Provider Business Mailing Address
First Line	:	PO BOX 2348
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49501-2348
Country	:	US
Telephone Number	:	800-968-6866
Fax Number	:

Provider Business Practice Location Address
First Line	:	10700 MCPHERSON AVE
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78045-6268
Country	:	US
Telephone Number	:	956-523-2098
Fax Number	:

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

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	07/08/2007

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