Provider Demographics
NPI:1902804123
Name:CANTU, ROEL E (MD)
Entity Type:Individual
Prefix:DR
First Name:ROEL
Middle Name:E
Last Name:CANTU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 W FM 495
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:TX
Mailing Address - Zip Code:78589-3717
Mailing Address - Country:US
Mailing Address - Phone:956-787-8100
Mailing Address - Fax:956-787-8117
Practice Address - Street 1:411 W FM 495
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:TX
Practice Address - Zip Code:78589-3717
Practice Address - Country:US
Practice Address - Phone:956-787-8100
Practice Address - Fax:956-787-8117
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4876208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX155370301Medicaid
TX155370301Medicaid
TX8A1665Medicare ID - Type UnspecifiedMEDICARE NUMBER