MEDICARE: PAMELA D 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	207R00000X	Internal Medicine Physician	H9836	TX

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	:	1437107901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA D CANTU M.D.

Provider Business Mailing Address
First Line	:	575 HILL COUNTRY DR
Second Line	:
City	:	KERRVILLE
State	:	TX
Zip	:	78028-6024
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1331 BANDERA HWY STE 4
Second Line	:
City	:	KERRVILLE
State	:	TX
Zip	:	78028-9535
Country	:	US
Telephone Number	:	830-258-7762
Fax Number	:	302-587-1188

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

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	06/14/2023

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