Paul J Cruz
Individual provider Active NPI Obstetrics & Gynecology Physician · Herrin, IL
NPI 1619956935 · NPPES record last updated Oct 22, 2011
Key facts
- NPI
- 1619956935
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Obstetrics & Gynecology Physician 207V00000X
- License
- 036077364 (IL)
- Practice address
- 3303 Logan Dr
Rea Clinic Herrin
Herrin, IL 62948 - Phone
- (618) 993-5767
- Fax
- (618) 724-2571
- NPI assigned
- Jan 13, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 036077364 | IL | Yes |
Addresses
Primary practice location
3303 Logan Dr
Rea Clinic Herrin
Herrin, IL 62948
Mailing address
PO Box 155
Christopher Greater Area Rural Health Planning Corp
Christopher, IL 62822
Phone (618) 724-2401
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 027163 | Other | IL | HEALTH ALLIANCE |
| 036077364 | Medicaid | IL | |
| 175114 | Other | IL | HEALTHLINK |
Other providers in Herrin, IL
- Erica Cowan
- Emmy Gael Crain
- Scott Wesley Cranick
- Amy Creek-Koehn
- Crossroads Home Care Services, LLC
- Maria Cull
- Darrell Scott Cutler
- Brian K. Daines
- Tracy Leanne Dalton
- Ruth Ann Daly
All providers in Herrin, IL · Obstetrics & Gynecology Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 22, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.