Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213ES0103X | Foot & Ankle Surgery | 2325 | TX |
Y | 213ES0131X | Foot Surgery | 2325 | TX |
NPI | 1205216751 |
---|---|
Provider Name | Dr. Fernando Michael Cruz |
First Address | Corsicana, TX 75110-4817 |
Second Address | Corsicana, TX 75110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2015 |
Last Update Date | 28/01/2021 |