=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023404084
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRANDON ROBERT CANTAZARO MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/07/2015
-----------------------------------------------------
Last Update Date | 09/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1330 E 6TH ST STE 105
-----------------------------------------------------
City | WESLACO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78596-6608
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-296-7710
-----------------------------------------------------
Fax | 956-296-7705
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 531968
-----------------------------------------------------
City | HARLINGEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78553-1968
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 833-887-4863
-----------------------------------------------------
Fax | 956-966-8572
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208M00000X
-----------------------------------------------------
Taxonomy Name | Hospitalist Physician
-----------------------------------------------------
License Number | R5523
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | R5523
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------