Provider Demographics
NPI:1083675359
Name:ZANTUA, OMAR A (MD)
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:A
Last Name:ZANTUA
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 1:8511 S SAM HOUSTON PKWY E
Mailing Address - Street 2:101
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77075-4857
Mailing Address - Country:US
Mailing Address - Phone:713-343-2301
Mailing Address - Fax:
Practice Address - Street 1:8511 S SAM HOUSTON PKWY E
Practice Address - Street 2:101
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77075-4857
Practice Address - Country:US
Practice Address - Phone:713-343-2301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0614207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX173870002Medicaid
TX173870002Medicaid
TXH63938Medicare UPIN