Provider Demographics
NPI:1083690077
Name:CACCHIONE, ROBERT JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JOSEPH
Last Name:CACCHIONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 W MAUD ST
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-4003
Mailing Address - Country:US
Mailing Address - Phone:573-727-5872
Mailing Address - Fax:573-785-2369
Practice Address - Street 1:1717 W MAUD ST
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-4003
Practice Address - Country:US
Practice Address - Phone:573-727-5872
Practice Address - Fax:573-785-2369
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9A34207ZP0102X
ARN-6500207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO36215OtherCENTRAL STATES
MO37110OtherENCOMPASS
AR90362OtherBLUE CROSS BLUE SHIELD
MO1180522OtherUNITED HEALTHCARE
MO1685OtherBLUE CROSS BLUE SHIELD
MO110659OtherHEALTHLINK
MO18339OtherBLUE CHOICE
E58572Medicare UPIN
MOT00010363Medicare ID - Type Unspecified