Provider Demographics
NPI:1891887519
Name:CANTU-LARA, ROBERTO JESUS (MD)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:JESUS
Last Name:CANTU-LARA
Suffix:
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 1:702 GALVESTON
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78040
Mailing Address - Country:US
Mailing Address - Phone:956-723-8224
Mailing Address - Fax:956-723-3994
Practice Address - Street 1:702 GALVESTON
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78040
Practice Address - Country:US
Practice Address - Phone:956-723-8224
Practice Address - Fax:956-723-3994
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4243207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
D48071Medicare UPIN
00T944Medicare ID - Type Unspecified