Healthcare Provider Details

I. General information

NPI: 1811082092
Provider Name (Legal Business Name): KENNETH C CABLE MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 11/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

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 Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number22364
License Number StateAZ

VIII. Authorized Official

Name: KENNETH C CABLE
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 480-789-2039