Provider Demographics
NPI:1043329980
Name:CABOT, CLYDE A (DO)
Entity Type:Individual
Prefix:MR
First Name:CLYDE
Middle Name:A
Last Name:CABOT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 17480
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85731-7480
Mailing Address - Country:US
Mailing Address - Phone:520-271-8603
Mailing Address - Fax:520-885-6080
Practice Address - Street 1:831 S RINCON RISING RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85748-6401
Practice Address - Country:US
Practice Address - Phone:520-271-8603
Practice Address - Fax:520-885-6080
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3868207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ777485Medicaid
74528Medicare ID - Type Unspecified
AZ777485Medicaid