MEDICARE: DR. PHILIP MARTINEZ CANTU 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	174400000X	Specialist	K2865	TX
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	36044	TX
3	208VP0014X	Interventional Pain Medicine Physician	08905	TX

General Provider Information

NPI Number	:	1235136607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILIP MARTINEZ CANTU M.D.

Provider Business Mailing Address
First Line	:	PO BOX 2859
Second Line	:
City	:	ORANGE
State	:	TX
Zip	:	77631-2859
Country	:	US
Telephone Number	:	409-883-4900
Fax Number	:	409-883-4913

Provider Business Practice Location Address
First Line	:	220 STRICKLAND DR
Second Line	:
City	:	ORANGE
State	:	TX
Zip	:	77630-4750
Country	:	US
Telephone Number	:	409-883-4900
Fax Number	:	409-883-4913

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

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	10/03/2012

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