Provider Demographics
NPI:1124081237
Name:CRUZ-MARTINEZ, EDGARDO (MD)
Entity type:Individual
Prefix:
First Name:EDGARDO
Middle Name:
Last Name:CRUZ-MARTINEZ
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 1:1500 SE MAGNOLIA EXT
Mailing Address - Street 2:SUITE 205
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-4463
Mailing Address - Country:US
Mailing Address - Phone:352-629-1800
Mailing Address - Fax:352-629-1888
Practice Address - Street 1:1500 SE MAGNOLIA EXT
Practice Address - Street 2:SUITE 205
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-4463
Practice Address - Country:US
Practice Address - Phone:352-629-1800
Practice Address - Fax:352-629-1888
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78169174400000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL281123500Medicaid
FL5482350OtherFIRST HEALTH
FL35563OtherBCBS
FL274278OtherAVMED
FLH17087Medicare UPIN
FL5482350OtherFIRST HEALTH
FL35563OtherBCBS