Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 21907 | NE |
Y | 111NI0900X | Internist | 21907 | NE |
N | 207R00000X | Internist | 34294 | IA |
N | 111NI0900X | Internist | 34294 | IA |
N | 207RG0300X | Geriatric Medicine | 34294 | IA |
N | 207RR0500X | Rheumatology | 34294 | IA |
NPI | 1053361915 |
---|---|
Provider Name | Abelardo C Cruz |
First Address | Omaha, NE 68103-0755 |
Second Address | Omaha, NE 68114-3321 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 19/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1053361915 | (05) | IA |
47068731798 | (05) | NE |
H54136 | (02) |