Provider Demographics
NPI:1326308263
Name:CANTU, CONRADO JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CONRADO
Middle Name:
Last Name:CANTU
Suffix:JR
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 1:4455 SPID DR
Mailing Address - Street 2:SUITE 116
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-5101
Mailing Address - Country:US
Mailing Address - Phone:361-993-1083
Mailing Address - Fax:
Practice Address - Street 1:2601 HOSPITAL BLVD
Practice Address - Street 2:SUITE 117
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78405-1815
Practice Address - Country:US
Practice Address - Phone:361-902-4789
Practice Address - Fax:361-902-4588
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-25
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ5361207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine