Provider Demographics
NPI:1962592022
Name:CACH, ROBERT LEE (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LEE
Last Name:CACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3360 S 15TH E
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-8321
Mailing Address - Country:US
Mailing Address - Phone:208-542-1050
Mailing Address - Fax:208-542-1150
Practice Address - Street 1:2375 E SUNNYSIDE RD STE G
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-8281
Practice Address - Country:US
Practice Address - Phone:208-542-1050
Practice Address - Fax:208-542-1150
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-7169207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDDG837OtherBLUE CROSS OF IDAHO
ID804252500Medicaid
ID000010003655OtherREGENCE BLUE SHIELD OF ID
ID1137135Medicare ID - Type Unspecified