Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 27122 | TN |
N | 207QA0505X | Family Doctor - Adult Medicine | 27122 | TN |
NPI | 1104886399 |
---|---|
Provider Name | Dr. Thomas Allen Cable |
First Address | Chattanooga, TN 37402-1226 |
Second Address | Chattanooga, TN 37402-1226 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
27122 | STATE MEDICAL LICENSE (01) | TN |
4073904 | BLUE CROSS/ BLUE SHIELD (01) | TN |
C83096 | (02) | TN |