Provider Demographics
NPI:1093755332
Name:KALANTAR, DAVID HORMOZ (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:HORMOZ
Last Name:KALANTAR
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 1:2495 SHREVEPORT HWY
Mailing Address - Street 2:# 71
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-4044
Mailing Address - Country:US
Mailing Address - Phone:787-613-5757
Mailing Address - Fax:787-830-6215
Practice Address - Street 1:7468 CALLE AGUSTIN RAMOS CALERO
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-4800
Practice Address - Country:US
Practice Address - Phone:787-830-6210
Practice Address - Fax:787-830-6215
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11486208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG65058Medicare UPIN
PR0084484Medicare ID - Type Unspecified