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General NPI Number Information
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NPI Number | 1215939665
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Entity Type | Organization
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Legal Business Name | MID-TEXAS HEALTH CARE ASSN., P.A.
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Dates
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Enumeration Date | 08/15/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1305 N MILAM ST
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City | FREDERICKSBURG
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State | TX
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Zip | 78624-2752
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Country | US
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Telephone | 830-997-7626
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Fax | 830-997-2641
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Provider Business Mailing Address
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Address Line | 1305 N MILAM ST
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City | FREDERICKSBURG
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State | TX
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Zip | 78624-2752
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Country | US
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Telephone | 830-997-7626
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Fax | 830-997-2641
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Authorized Official
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Title or Position | OWNER/PARTNER
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Name | DR. DAVID A CANTU
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Credential | M.D.
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Telephone | 830-997-7626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | J1073
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License Number State | TX
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