Provider Demographics
NPI:1518337013
Name:CANTU, JOHN (IDC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:CANTU
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7204 COUNTY ROAD 4167
Mailing Address - Street 2:
Mailing Address - City:TAFT
Mailing Address - State:TX
Mailing Address - Zip Code:78390-8131
Mailing Address - Country:US
Mailing Address - Phone:361-815-7095
Mailing Address - Fax:
Practice Address - Street 1:7204 COUNTY ROAD 4167
Practice Address - Street 2:
Practice Address - City:TAFT
Practice Address - State:TX
Practice Address - Zip Code:78390-8131
Practice Address - Country:US
Practice Address - Phone:361-815-7095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-28
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman