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Individual

RAFAEL CRUZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1700 DIVIDEND DR, LOGANSPORT, IN 46947-1572
(574) 722-7407
(574) 735-0429
Mailing address
1700 DIVIDEND DR, LOGANSPORT, IN 46947-1572
(574) 722-7407
(574) 735-0429

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01046661A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
003102887
NV
05
1025449080001
PA
01
10380
MEDICAL LICENSE
NV
01
221853-1
MEDICAL LICENSE
NY
01
CS11551
PHARMACY CERTIFICATE
NV
01
MD-073155-L
MEDICAL LICENSE
PA
Enumeration date
07/18/2006
Last updated
03/07/2023
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