Provider Demographics
NPI:1669647137
Name:STEPHEN A. CANTOR, M.D., P.C.
Entity Type:Organization
Organization Name:STEPHEN A. CANTOR, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-308-4287
Mailing Address - Street 1:980 WILLOW CREEK RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-1611
Mailing Address - Country:US
Mailing Address - Phone:928-445-4142
Mailing Address - Fax:928-776-9491
Practice Address - Street 1:980 WILLOW CREEK RD
Practice Address - Street 2:SUITE 201
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1611
Practice Address - Country:US
Practice Address - Phone:928-445-4142
Practice Address - Fax:928-776-9491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22564207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty