MEDICARE: ERWIN A 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	174400000X	Specialist	H5860	TX

General Provider Information

NPI Number	:	1952308231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERWIN A CRUZ MD

Provider Business Mailing Address
First Line	:	PO BOX 1313
Second Line	:
City	:	ADDISON
State	:	TX
Zip	:	75001-1313
Country	:	US
Telephone Number	:	972-991-9950
Fax Number	:	972-991-9548

Provider Business Practice Location Address
First Line	:	12800 PRESTON RD
Second Line	:	STE 101
City	:	DALLAS
State	:	TX
Zip	:	75230-1366
Country	:	US
Telephone Number	:	972-503-2780
Fax Number	:	972-503-2783

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

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	07/08/2007

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