Provider Demographics
NPI:1821093287
Name:CATHCART, DAVID LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LEE
Last Name:CATHCART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 777
Mailing Address - Street 2:304 W. WASHINGTON AVENUE
Mailing Address - City:RICHLAND
Mailing Address - State:MO
Mailing Address - Zip Code:65556-0777
Mailing Address - Country:US
Mailing Address - Phone:573-765-5131
Mailing Address - Fax:573-765-3122
Practice Address - Street 1:948 E US HIGHWAY 54
Practice Address - Street 2:
Practice Address - City:CAMDENTON
Practice Address - State:MO
Practice Address - Zip Code:65020-6834
Practice Address - Country:US
Practice Address - Phone:573-346-4446
Practice Address - Fax:573-346-7501
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2016-07-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO109547207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208209049Medicaid
P00836332OtherRAILROAD MEDICARE
MO431560263OtherTRICARE WEST
MO002013314OtherPTAN
MO132300120Medicare PIN
MO208209049Medicaid