Provider Demographics
NPI:1437107901
Name:CANTU, PAMELA D (MD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:D
Last Name:CANTU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 HILL COUNTRY DR
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-6024
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1331 BANDERA HWY STE 4
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-9535
Practice Address - Country:US
Practice Address - Phone:830-258-7762
Practice Address - Fax:302-587-1188
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9836207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128479601Medicaid
TX80100BMedicare ID - Type Unspecified
TXF58599Medicare UPIN