Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | J5271 | TX |
NPI | 1013917418 |
---|---|
Provider Name | George Cantu |
First Address | Raymondville, TX 78580-2547 |
Second Address | Raymondville, TX 78580-2547 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2005 |
Last Update Date | 23/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F19607 | (02) | TX |