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BRADLEY J CAPAWANA D.P.M.

Foot & Ankle Surgery >> Podiatrist >> Podiatric Medicine & Surgery Service Providers

Registrant NPI Number: 1447257076

Individual Registrant:
 BRADLEY J CAPAWANA D.P.M.
Gender: M
Sole Proprietor

Location and contact information for practice:
619 S WASHINGTON ST STE 103 MOSCOW, ID 83843-3090 US
Tel: 509-334-4498  Fax: 509-334-0380

Contact information for business:
825 SE BISHOP BLVD STE 801 PULLMAN, WA 99163-5538 US
Tel: 509-334-4498  Fax: 509-334-0380

Registration Information:
NPI: 1447257076
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
N213ES0103XPodiatric Medicine & Surgery Service Providers
Podiatrist
Foot & Ankle Surgery
UT953122850501
Y213ES0103XPodiatric Medicine & Surgery Service Providers
Podiatrist
IDP159
N213ES0103XPodiatric Medicine & Surgery Service Providers
Podiatrist
WAPO00000638

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
1108034WA05
805505000ID05




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