Provider Demographics
NPI:1164440814
Name:CANTU, AMADOR RAMIREZ (DO)
Entity Type:Individual
Prefix:DR
First Name:AMADOR
Middle Name:RAMIREZ
Last Name:CANTU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 S 1000 W
Mailing Address - Street 2:
Mailing Address - City:BLACKFOOT
Mailing Address - State:ID
Mailing Address - Zip Code:83221-6085
Mailing Address - Country:US
Mailing Address - Phone:208-684-4958
Mailing Address - Fax:
Practice Address - Street 1:354 S 1000 W
Practice Address - Street 2:
Practice Address - City:BLACKFOOT
Practice Address - State:ID
Practice Address - Zip Code:83221-6085
Practice Address - Country:US
Practice Address - Phone:208-684-4958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO-0416207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine