Basic Information
| Provider Information | |||||||||
| NPI: | 1205880549 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAGLE | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | DALE | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1500 N OAKLAND AVE | ||||||||
| Address2: | |||||||||
| City: | BOLIVAR | ||||||||
| State: | MO | ||||||||
| PostalCode: | 656133011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4173266000 | ||||||||
| FaxNumber: | 4173286338 | ||||||||
| Practice Location | |||||||||
| Address1: | 1245 N BUTTERFIELD RD | ||||||||
| Address2: | |||||||||
| City: | BOLIVAR | ||||||||
| State: | MO | ||||||||
| PostalCode: | 656133017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4173287702 | ||||||||
| FaxNumber: | 4177777881 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2006 | ||||||||
| LastUpdateDate: | 12/14/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 2005007763 | MO | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.