Basic Information
| Provider Information | |||||||||
| NPI: | 1225349111 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CODY | ||||||||
| FirstName: | CATHY | ||||||||
| MiddleName: | JO | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 670 MASON RIDGE CENTER DR | ||||||||
| Address2: | STE 300 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631418573 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5736825580 | ||||||||
| FaxNumber: | 5736821539 | ||||||||
| Practice Location | |||||||||
| Address1: | 1021 E HIGHWAY 22 | ||||||||
| Address2: | |||||||||
| City: | CENTRALIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652401183 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5736825580 | ||||||||
| FaxNumber: | 5736821539 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2010 | ||||||||
| LastUpdateDate: | 03/15/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2010020729 | MO | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 2012011167 | MO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.