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Organization
CHARLES J. LASTRAPES, D.O., LLC
Active
Organization
CHARLES J. LASTRAPES, D.O., LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES JOSEPH LASTRAPES JR. D.O. (PHYSICIAN)
(573) 335-8282
Entity
Organization
Contact information
Practice address
937 BROADWAY ST, SUITE 203, CAPE GIRARDEAU, MO 63701-5493
(573) 335-8288
Mailing address
937 BROADWAY ST, SUITE 203, CAPE GIRARDEAU, MO 63701-5493
(573) 335-8288
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
112343
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107336
BLUE CROSS BLUE SHIELD
MO
01
—
283223
CMR
MO
01
—
335767
HEALTHLINK
MO
01
—
DF0280
RAILROAD MEDICARE
MO
Enumeration date
08/08/2006
Last updated
05/30/2008
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