MEDICARE: DR. ROBERT LORIN CANTRELL M.D

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	F6504	TX
2	207Q00000X	Family Medicine Physician	83173	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144225822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT LORIN CANTRELL M.D

Provider Business Mailing Address
First Line	:	PO BOX 660599
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75266-0599
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9202 ELAM RD
Second Line	:	SOUTHEAST DALLAS HEALTH CENTER
City	:	DALLAS
State	:	TX
Zip	:	75217-4151
Country	:	US
Telephone Number	:	214-266-1600
Fax Number	:	214-266-1790

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

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	12/20/2012

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