Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | MD00038278 | WA |
NPI | 1083665145 |
---|---|
Provider Name | Michael Joseph Cruz |
First Address | Spokane, WA 99210-2242 |
Second Address | Spokane, WA 99201-2217 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2006 |
Last Update Date | 12/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1001980 | (05) | WA |
135354 | L & I (01) | WA |
H13411 | (02) |