Individual
DR. GERALD VAN CUPP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1605 E BROADWAY, SUITE 300, COLUMBIA, MO 65201-8023
(573) 256-7700
Mailing address
1015 MARCASSIN DR, COLUMBIA, MO 65201-7196
(573) 449-1576
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
R3945
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200582302
—
MO
Enumeration date
07/08/2008
Last updated
06/10/2009
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