Individual
PAUL IVAN DCRUZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7714 CONNER RD STE 105, POWELL, TN 37849
(865) 947-6220
(864) 512-1069
Mailing address
6350 W ANDREW JOHNSON HWY DEPT 100, TALBOTT, TN 37877-8605
(800) 355-3565
(423) 714-2355
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MD31332
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3895650
—
TN
Enumeration date
07/21/2005
Last updated
09/28/2020
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