Provider Demographics
NPI:1861406324
Name:CABLE, DOUGLAS CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:CHARLES
Last Name:CABLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:320 SUPERIOR AVE #290
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663
Mailing Address - Country:US
Mailing Address - Phone:949-574-2628
Mailing Address - Fax:949-574-2185
Practice Address - Street 1:320 SUPERIOR AVE #290
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663
Practice Address - Country:US
Practice Address - Phone:949-574-2628
Practice Address - Fax:949-574-2185
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG39307207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G393070Medicaid
CA00G393070Medicaid
CAG39307Medicare ID - Type Unspecified