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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