MEDICARE: RAMON OMAR CANTU D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	K5266	TX
2	207P00000X	Emergency Medicine Physician	K5266	TX

General Provider Information

NPI Number	:	1023049863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAMON OMAR CANTU D.O.

Provider Business Mailing Address
First Line	:	610 SOUTH AUSTIN ROAD
Second Line	:
City	:	EAGLE LAKE
State	:	TX
Zip	:	77434-3202
Country	:	US
Telephone Number	:	979-234-2551
Fax Number	:	979-234-5994

Provider Business Practice Location Address
First Line	:	610 SOUTH AUSTIN ROAD
Second Line	:
City	:	EAGLE LAKE
State	:	TX
Zip	:	77434-3202
Country	:	US
Telephone Number	:	979-234-2551
Fax Number	:	979-234-5994

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	12/07/2011

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Directions to “ RAMON OMAR CANTU D.O.” Practice Location

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