Basic Information
Provider Information
NPI: 1598812778
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CABLE
FirstName: CHRISTOPHER
MiddleName: J.
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 34584
Address2:  
City: SEATTLE
State: WA
PostalCode: 981241584
CountryCode: US
TelephoneNumber: 5092417349
FaxNumber: 5092417628
Practice Location
Address1: 2700 152ND AVE NE
Address2: D-221
City: REDMOND
State: WA
PostalCode: 980525543
CountryCode: US
TelephoneNumber: 4258835151
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/03/2007
LastUpdateDate: 10/29/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XMD00037846WAY Allopathic & Osteopathic PhysiciansInternal Medicine 
208M00000XMD00037846WAN Allopathic & Osteopathic PhysiciansHospitalist 

ID Information
IDTypeStateIssuerDescription
825319705WA MEDICAID


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