Provider Demographics
NPI:1255410833
Name:CABAN, MABEL E (MD)
Entity type:Individual
Prefix:
First Name:MABEL
Middle Name:E
Last Name:CABAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3599 UNIVERSITY BLVD S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4252
Mailing Address - Country:US
Mailing Address - Phone:904-345-7776
Mailing Address - Fax:904-345-7772
Practice Address - Street 1:3901 UNIVERSITY BLVD S STE 103
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216
Practice Address - Country:US
Practice Address - Phone:904-345-7373
Practice Address - Fax:904-345-7372
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0059208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX147493401Medicaid
TX147493401Medicaid
TXD08488Medicare UPIN