Provider Demographics
NPI:1346447158
Name:CABRERA, TOMAS V (MD)
Entity Type:Individual
Prefix:MR
First Name:TOMAS
Middle Name:V
Last Name:CABRERA
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 1:19 OAK BLUFF DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-1801
Mailing Address - Country:US
Mailing Address - Phone:636-561-1955
Mailing Address - Fax:573-324-6521
Practice Address - Street 1:13698 PIKE 46 AIRPORT ROAD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:MO
Practice Address - Zip Code:63334
Practice Address - Country:US
Practice Address - Phone:573-324-9975
Practice Address - Fax:573-324-6521
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO33062171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA10778Medicare UPIN