Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | N0721 | TX |
Y | 208600000X | Surgeon | N0721 | TX |
N | 208200000X | Surgeon | MD27611 | OR |
N | 208600000X | Surgeon | MD27611 | OR |
N | 2086S0105X | Surgery of the Hand | MD27611 | OR |
N | 2086S0105X | Surgery of the Hand | MD60016651 | WA |
N | 2086S0105X | Surgery of the Hand | N0721 | TX |
NPI | 1922208164 |
---|---|
Provider Name | Dr. Emmanuel Avelino Delacruz JR. |
First Address | The Woodlands, TX 77380-2575 |
Second Address | The Woodlands, TX 77380-2575 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2007 |
Last Update Date | 10/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
312313YUR9 | MEDICARE PTAN (01) | TX |
340811401 | (05) | TX |