Provider Demographics
NPI:1063603553
Name:CRUZ, ANTONIO P (MD)
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:P
Last Name:CRUZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1287 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-1856
Mailing Address - Country:US
Mailing Address - Phone:401-272-2724
Mailing Address - Fax:401-272-2784
Practice Address - Street 1:1287 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-1856
Practice Address - Country:US
Practice Address - Phone:401-272-2724
Practice Address - Fax:401-272-2784
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA246717207ND0101X, 207N00000X
RIMD13344207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology