Individual
RAFAEL DE LA CRUZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4 MEMORIAL DR STE 230B, ALTON, IL 62002-6705
(636) 344-2014
(314) 747-1476
Mailing address
670 MASON RIDGE CENTER DR, STE. 300, SAINT LOUIS, MO 63141-8573
(636) 344-2014
(314) 747-1476
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
036-108921
IL
207RI0200X
Infectious Disease Physician
2008007441
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1669460655
—
MO
Enumeration date
10/12/2005
Last updated
02/26/2021
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