Healthcare Provider Details

I. General information

NPI: 1922068410
Provider Name (Legal Business Name): ERIC T. CABLE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 11/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1613 HARRISON PKWY #00
SUNRISE FL
33323-2853
US

IV. Provider business mailing address

PO BOX 452137
SUNRISE FL
33345-2137
US

V. Phone/Fax

Practice location:
  • Phone: 954-838-2371
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA0381
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: