Provider Demographics
NPI:1871588723
Name:CRUZ, JULIO C (MD)
Entity type:Individual
Prefix:
First Name:JULIO
Middle Name:C
Last Name:CRUZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5720 BLAZER PARKWAY
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017
Mailing Address - Country:US
Mailing Address - Phone:614-761-1151
Mailing Address - Fax:614-761-4893
Practice Address - Street 1:5720 BLAZER PARKWAY
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017
Practice Address - Country:US
Practice Address - Phone:614-761-1151
Practice Address - Fax:614-761-4893
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35063722C207ND0900X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0934887Medicaid
OHF62940Medicare UPIN
OHCR0744397Medicare ID - Type Unspecified
OH0934887Medicaid