Provider Demographics
NPI:1619274677
Name:CANTU, JESSICA ANNE (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANNE
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 1:12200 RENFERT WAY STE G-3
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-5654
Mailing Address - Country:US
Mailing Address - Phone:512-821-2540
Mailing Address - Fax:
Practice Address - Street 1:3000 N INTERSTATE 35 STE 655
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1859
Practice Address - Country:US
Practice Address - Phone:512-821-2540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-27
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN9029207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL128257Medicaid
AL128264Medicaid
AL128275Medicaid
AL051116318OtherBCBS
AL051116321OtherBCBS
AL128254Medicaid
AL128267Medicaid
AL051116314OtherBCBS
AL051116316OtherBCBS
AL051116322OtherBCBS
AL128248Medicaid
AL128268Medicaid
AL051116323OtherBCBS
AL051116325OtherBCBS
AL128273Medicaid
AL051116312OtherBCBS
AL051116313OtherBCBS
AL051116319OtherBCBS
AL051116320OtherBCBS
AL051116324OtherBCBS
AL128249Medicaid
AL128251Medicaid
AL128271Medicaid
AL051116315OtherBCBS
AL051116317OtherBCBS
AL128255Medicaid
MS01826866Medicaid
AL128260Medicaid
AL128270Medicaid
AL128260Medicaid