Active NPI
Eligio Cornejo Cruz, M.D.
- Specialist
- Saint Louis, MO
National Provider Identifier
1528320660
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 33078
- Practice address
- 110 Wyckcliffe PL
Saint Louis, MO 63141-8047 - Phone
- (314) 780-4008
- NPI assigned
- Jun 14, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 33078 | MO | Primary |
| Obstetrics & Gynecology Physician | 207V00000X | 33078 | MO |
Addresses
Primary practice location
110 Wyckcliffe PL
Saint Louis, MO 63141-8047
Mailing address
110 Wyckcliffe PL
Saint Louis, MO 63141-8047
Phone (314) 780-4008
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 33078 | MO | MD | Obstetrics & Gynecology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1339632000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1339632000000",
"number": "1528320660",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "110 WYCKCLIFFE PL",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631418047",
"telephone_number": "314-780-4008"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 WYCKCLIFFE PL",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631418047",
"telephone_number": "314-780-4008"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRUZ",
"first_name": "ELIGIO",
"middle_name": "CORNEJO",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-06-14",
"last_updated": "2012-06-14",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "MO",
"license": "33078",
"primary": true
},
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "MO",
"license": "33078",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.