Provider Demographics
NPI:1013917418
Name:CANTU, GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:CANTU
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 1:182 E KIMBALL AVE
Mailing Address - Street 2:
Mailing Address - City:RAYMONDVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78580-2547
Mailing Address - Country:US
Mailing Address - Phone:956-689-2225
Mailing Address - Fax:956-689-3070
Practice Address - Street 1:182 E KIMBALL AVE
Practice Address - Street 2:
Practice Address - City:RAYMONDVILLE
Practice Address - State:TX
Practice Address - Zip Code:78580-2547
Practice Address - Country:US
Practice Address - Phone:956-689-2225
Practice Address - Fax:956-689-3070
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5271207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00N17WMedicare PIN
TXF19607Medicare UPIN