Provider Demographics
NPI:1396713616
Name:CANALES, ERASTO (MD)
Entity type:Individual
Prefix:
First Name:ERASTO
Middle Name:
Last Name:CANALES
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 1:334 LINDBERG AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-2943
Mailing Address - Country:US
Mailing Address - Phone:956-686-2020
Mailing Address - Fax:956-686-3094
Practice Address - Street 1:334 LINDBERG AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-2943
Practice Address - Country:US
Practice Address - Phone:956-686-2020
Practice Address - Fax:956-686-3094
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-11
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126917704OtherTX HEALTH STEPS
TX126917703Medicaid
TX00K10YMedicare PIN
TX126917703Medicaid