Provider Demographics
NPI:1275598187
Name:CANTU, CESAR EMILIO (MD)
Entity Type:Individual
Prefix:
First Name:CESAR
Middle Name:EMILIO
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 1:731 ARMADILLO LN
Mailing Address - Street 2:
Mailing Address - City:COPPERAS COVE
Mailing Address - State:TX
Mailing Address - Zip Code:76522-6144
Mailing Address - Country:US
Mailing Address - Phone:254-780-7626
Mailing Address - Fax:
Practice Address - Street 1:5702 E CENTRAL TEXAS EXPY
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76543-5500
Practice Address - Country:US
Practice Address - Phone:254-680-7301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH1691207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00195365OtherRR/MEDICARE
TX8J9876OtherBLUE SHIELD
TX1351074-12OtherCSHCN
TX1351074-11Medicaid
TX8B2483Medicare ID - Type Unspecified
TX1351074-11Medicaid