# CHARLES J. LASTRAPES, D.O., LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497765994
- **Authorized official:** DR. CHARLES JOSEPH LASTRAPES JR. D.O. (PHYSICIAN)
- **Authorized official phone:** (573) 335-8282

## Contact information

- **Practice address:** 937 BROADWAY ST, SUITE 203, CAPE GIRARDEAU, MO 63701-5493
- **Practice address phone:** (573) 335-8288
- **Mailing address:** 937 BROADWAY ST, SUITE 203, CAPE GIRARDEAU, MO 63701-5493
- **Mailing address phone:** (573) 335-8288

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 112343 | MO | Yes |

## Other

- **Enumeration date:** 08/08/2006
- **Last updated:** 05/30/2008

## 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 |