Individual
STEPHEN CRUZE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
1055 N 500 W, SUITE 121, PROVO, UT 84604-3305
(801) 373-7350
Mailing address
1055 N 500 W, CREDENTIALING DEPARTMENT, PROVO, UT 84604-3305
(801) 429-8000
(801) 429-8150
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
7398126-1206
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7398126-1206
STATE LICENSE
UT
Enumeration date
07/02/2009
Last updated
07/02/2009
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