Provider Demographics
NPI:1205030392
Name:CABELL, ADAM PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:PATRICK
Last Name:CABELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 S CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-4176
Mailing Address - Country:US
Mailing Address - Phone:870-910-6654
Mailing Address - Fax:870-932-0526
Practice Address - Street 1:800 S CHURCH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4176
Practice Address - Country:US
Practice Address - Phone:870-910-6654
Practice Address - Fax:870-932-0526
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR355042085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
BP2-0018187OtherINSTITUTIONAL PERMIT
AR5H161OtherMEDICARE
AR168423001Medicaid