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General NPI Number Information
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NPI Number | 1760882484
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Entity Type | Individual
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Provider Name | RORY DAVID CAVAILLE PHARMD/PA-C
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Gender | Male
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Dates
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Enumeration Date | 08/29/2014
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Last Update Date | 03/31/2021
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Provider Practice Location Address
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Address Line | 275 BRONSON WAY NE
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City | RENTON
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State | WA
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Zip | 98056-4030
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Country | US
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Telephone | 425-235-2808
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Fax | 425-235-2835
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Provider Business Mailing Address
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Address Line | 3400 NE 110TH ST APT 103
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City | SEATTLE
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State | WA
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Zip | 98125-6855
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Country | US
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Telephone | 360-350-2546
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA60797612
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License Number State | WA
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