Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 0101234474 | VA |
N | 2080P0214X | Pediatric Pulmonologist | 0101234474 | VA |
NPI | 1518968940 |
---|---|
Provider Name | Dr. Jason Blair Caboot |
First Address | Gig Harbor, WA 98335-8454 |
Second Address | Tacoma, WA 98431-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2005 |
Last Update Date | 27/01/2020 |