Provider Demographics
NPI:1104311794
Name:REYES CRUZ, ALAN ALEJANDRO (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:ALEJANDRO
Last Name:REYES CRUZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3903 S 7TH ST STE 2F
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-5710
Mailing Address - Country:US
Mailing Address - Phone:812-234-5400
Mailing Address - Fax:812-234-5420
Practice Address - Street 1:3903 S 7TH ST STE 2F
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-5710
Practice Address - Country:US
Practice Address - Phone:812-234-5400
Practice Address - Fax:812-234-5420
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01089059A208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery