Provider Demographics
NPI:1417920455
Name:PULCHER, ROBERT WAYNE (PHD PSYCHOLOGIST)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:WAYNE
Last Name:PULCHER
Suffix:
Gender:M
Credentials:PHD PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX F
Mailing Address - Street 2:502 BURKARTH RD STE D
Mailing Address - City:WARRENSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64093-0890
Mailing Address - Country:US
Mailing Address - Phone:660-429-6678
Mailing Address - Fax:660-429-6672
Practice Address - Street 1:502 BURKARTH RD
Practice Address - Street 2:STE D
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093-3104
Practice Address - Country:US
Practice Address - Phone:660-429-6678
Practice Address - Fax:660-429-6672
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00404103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO06714038OtherBCBS
MO7587473001OtherMEDICAID QMB
MO7587473001OtherMEDICAID QMB