Provider Demographics
NPI:1235136607
Name:CANTU, PHILIP MARTINEZ (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:MARTINEZ
Last Name:CANTU
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:PO BOX 2859
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:TX
Mailing Address - Zip Code:77631-2859
Mailing Address - Country:US
Mailing Address - Phone:409-883-4900
Mailing Address - Fax:409-883-4913
Practice Address - Street 1:220 STRICKLAND DR
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:TX
Practice Address - Zip Code:77630-4750
Practice Address - Country:US
Practice Address - Phone:409-883-4900
Practice Address - Fax:409-883-4913
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2865174400000X
TX36044207LP2900X
TX08905208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No174400000XOther Service ProvidersSpecialist
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00308MMedicare ID - Type Unspecified
TXG50538Medicare UPIN