Provider Demographics
NPI:1972053536
Name:CAWTHON, ROBERT W JR
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:CAWTHON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 S EBERHART RD
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-2842
Mailing Address - Country:US
Mailing Address - Phone:724-487-4746
Mailing Address - Fax:815-550-1947
Practice Address - Street 1:239 S EBERHART RD
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-2842
Practice Address - Country:US
Practice Address - Phone:724-487-4746
Practice Address - Fax:815-550-1947
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-07
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA708933171W00000X
VA974938171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA974938OtherVIRGINIA ACCIDENT HEALTH PRODUCER
PA708933OtherPENNSYLVANIA ACCIDENT HEALTH LIFE PRODUCER