Healthcare Provider Details

I. General information

NPI: 1437107901
Provider Name (Legal Business Name): PAMELA D CANTU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 BANDERA HWY STE 4
KERRVILLE TX
78028-9535
US

IV. Provider business mailing address

575 HILL COUNTRY DR
KERRVILLE TX
78028-6024
US

V. Phone/Fax

Practice location:
  • Phone: 830-258-7762
  • Fax: 302-587-1188
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberH9836
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: