Provider Demographics
NPI:1285625400
Name:JUAREZ, EDWARD CRUZ (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:CRUZ
Last Name:JUAREZ
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2260 TRAWOOD DR STE C
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-3042
Mailing Address - Country:US
Mailing Address - Phone:915-591-4632
Mailing Address - Fax:915-591-4069
Practice Address - Street 1:2260 TRAWOOD DR STE C
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-3042
Practice Address - Country:US
Practice Address - Phone:915-591-4632
Practice Address - Fax:915-591-4069
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5327207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138390315Medicaid
NM110173087OtherPALMETTO GBA
TX110134288OtherPALMETTO GBA
TX437900YLPSOtherWELLMED PTAN
NM16782Medicaid
TX138390304Medicaid
TX437900YLPSOtherWELLMED PTAN
TXA78336Medicare UPIN
TX138390304Medicaid