Healthcare Provider Details

I. General information

NPI: 1295729168
Provider Name (Legal Business Name): KENNETH C CABLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date: 03/25/2006
Reactivation Date: 04/12/2006

III. Provider practice location address

39810 N 105TH WAY
SCOTTSDALE AZ
85262-3314
US

IV. Provider business mailing address

PO BOX 13837
SCOTTSDALE AZ
85267-3837
US

V. Phone/Fax

Practice location:
  • Phone: 480-789-2039
  • Fax: 480-595-9862
Mailing address:
  • Phone: 480-789-2039
  • Fax: 480-595-9862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number22364
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: