Provider Demographics
NPI:1023404084
Name:CANTAZARO, BRANDON ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:ROBERT
Last Name:CANTAZARO
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:PO BOX 531968
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78553-1968
Mailing Address - Country:US
Mailing Address - Phone:833-887-4863
Mailing Address - Fax:956-966-8572
Practice Address - Street 1:1330 E 6TH ST STE 105
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-6608
Practice Address - Country:US
Practice Address - Phone:956-296-7710
Practice Address - Fax:956-296-7705
Is Sole Proprietor?:No
Enumeration Date:2015-04-07
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR5523208M00000X, 207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8JT012OtherBCBS
TX3852444-01Medicaid