Healthcare Provider Details

I. General information

NPI: 1235648551
Provider Name (Legal Business Name): ROBERT CALALUCE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2017
Last Update Date: 09/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 WALTER WILLIAMS HALL
COLUMBIA MO
65211-1200
US

IV. Provider business mailing address

1421 KENT RD
MEXICO MO
65265-1142
US

V. Phone/Fax

Practice location:
  • Phone: 573-882-4204
  • Fax: 573-882-4204
Mailing address:
  • Phone: 573-253-9581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number106793
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: