Provider Demographics
NPI:1407850290
Name:KANTOR, GEROME B (MD)
Entity Type:Individual
Prefix:DR
First Name:GEROME
Middle Name:B
Last Name:KANTOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1951 N. WILMOT BLDG. #3
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712
Mailing Address - Country:US
Mailing Address - Phone:520-327-9573
Mailing Address - Fax:520-323-3179
Practice Address - Street 1:7370 N LA CHOLLA BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-2305
Practice Address - Country:US
Practice Address - Phone:520-742-6863
Practice Address - Fax:520-742-6443
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33132207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AS30059663OtherTAT
AZAZ0764240OtherBLUE CROSS BLUE SHIELD
AZ9882377OtherCIGNA
AZ85472Medicare PIN
AZE14052Medicare UPIN
AS30059663OtherTAT