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Individual

DR. OSWALDO CRUZ BACANI SR.

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1525 MADISON ST STE 3, FREDONIA, KS 66736-1704
(620) 378-3700
(620) 378-3536
Mailing address
PO BOX 576, FREDONIA, KS 66736-0576
(620) 378-3700
(620) 378-3536

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
04-17538
KS
208600000X
Surgery Physician
04-17538
KS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0000002897
BLUE CROSS BLUE SHIELD
KS
05
100087030-A
KS
Enumeration date
08/17/2006
Last updated
10/07/2009
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