Individual
DR. THERESA A CAVINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
255 BODERMAN, BLOOMSDALE, MO 63627-9099
(573) 483-2525
Mailing address
PO BOX 366, STE GENEVIEVE, MO 63670-0366
(573) 883-4477
(573) 883-4477
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
110454
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020048156
RAILROAD MEDICARE
MO
Enumeration date
10/02/2005
Last updated
04/18/2013
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