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Individual

CHARLES J LASTRAPES

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
408 S BROADVIEW ST, CAPE GIRARDEAU, MO 63703-5725
(573) 332-0808
(573) 339-7945
Mailing address
408 S BROADVIEW ST, CAPE GIRARDEAU, MO 63703-5725
(573) 332-0808
(573) 339-7945

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DO112343
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1760483036
MO
Enumeration date
08/09/2005
Last updated
06/10/2011
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