Provider Demographics
NPI:1528105285
Name:PAGAN DELGADO, CRUZ EDGARDO (MD)
Entity type:Individual
Prefix:MR
First Name:CRUZ
Middle Name:EDGARDO
Last Name:PAGAN DELGADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:CRUZ
Other - Middle Name:EDGARDO
Other - Last Name:PAGAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:403 E 11TH ST
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-3409
Mailing Address - Country:US
Mailing Address - Phone:850-747-5599
Mailing Address - Fax:
Practice Address - Street 1:11033 NW STATE ROAD 20
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:FL
Practice Address - Zip Code:32321-6406
Practice Address - Country:US
Practice Address - Phone:850-643-1155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN486208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHK272ZOtherMEDICARE PTAN
FLHK272ZOtherMEDICARE PTAN
PRMCS110578OtherMCS
PRSSS82828OtherSSS
PRSSS82828OtherSSS