Provider Demographics
NPI:1427291491
Name:CANTU, NORMA S (MD)
Entity type:Individual
Prefix:DR
First Name:NORMA
Middle Name:S
Last Name:CANTU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NORMA
Other - Middle Name:
Other - Last Name:CANTU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:625 ALBANY AVE
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:WY
Mailing Address - Zip Code:82240-1530
Mailing Address - Country:US
Mailing Address - Phone:301-575-9804
Mailing Address - Fax:
Practice Address - Street 1:625 ALBANY AVE
Practice Address - Street 2:BANNER MEDICAL CLINIC
Practice Address - City:TORRINGTON
Practice Address - State:WY
Practice Address - Zip Code:82240-1530
Practice Address - Country:US
Practice Address - Phone:307-532-2107
Practice Address - Fax:307-532-5617
Is Sole Proprietor?:No
Enumeration Date:2009-04-07
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY8091A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW22628Medicare PIN
WYW22627Medicare PIN