Basic Information
| Provider Information | |||||||||
| NPI: | 1205030392 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CABELL | ||||||||
| FirstName: | ADAM | ||||||||
| MiddleName: | PATRICK | ||||||||
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| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 S CHURCH ST | ||||||||
| Address2: | |||||||||
| City: | JONESBORO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724014176 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8709106654 | ||||||||
| FaxNumber: | 8709320526 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 S CHURCH ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | JONESBORO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724014176 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8709106654 | ||||||||
| FaxNumber: | 8709320526 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2007 | ||||||||
| LastUpdateDate: | 04/03/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 35504 | AR | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | BP2-0018187 | 01 | INSTITUTIONAL PERMIT | OTHER | 5H161 | 01 | AR | MEDICARE | OTHER | 168423001 | 05 | AR | MEDICAID |