Provider Demographics
NPI:1588699839
Name:CANTRELL, JOHN E (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:E
Last Name:CANTRELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38601-0160
Mailing Address - Country:US
Mailing Address - Phone:662-513-9699
Mailing Address - Fax:662-513-9651
Practice Address - Street 1:504 AZALEA DR
Practice Address - Street 2:RADIATION ONCOLOGY DEPARTMENT
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5397
Practice Address - Country:US
Practice Address - Phone:662-513-9699
Practice Address - Fax:662-513-9651
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS090912085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0120651Medicaid
MSB04695Medicare UPIN
MS0120651Medicaid