BRADLEY J CAPAWANA (NPI# 1447257076) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1447257076 |
| Entity Type | Individual |
| Full Name | BRADLEY J CAPAWANA |
| Credential | D.P.M. |
| Practice Address |
619 S Washington St Ste 103 Moscow ID 83843-3090 |
| Mailing Address |
825 Se Bishop Blvd Ste 801 Pullman WA 99163-5538 |
| Practice Telephone | 5093344498 |
| Practice Fax Number | 5093340380 |
| Mailing Telephone | 5093344498 |
| Mailing Fax Number | 5093340380 |
| Enumeration Date | 2005-06-28 |
| Last Update Date | 2017-02-20 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 213ES0103X |
Podiatrist Specialization: Foot & Ankle Surgery |
953122850501 | UT | Podiatric Medicine & Surgery Service Providers |
| Y | 213ES0103X |
Podiatrist Specialization: Foot & Ankle Surgery |
P159 | ID | Podiatric Medicine & Surgery Service Providers |
| N | 213ES0103X |
Podiatrist Specialization: Foot & Ankle Surgery |
PO00000638 | WA | Podiatric Medicine & Surgery Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | 1108034 | 05 | |
| ID | 805505000 | 05 |
| Street Address |
619 S WASHINGTON ST STE 103 |
| City | MOSCOW |
| State | ID |
| Zip Code | 83843-3090 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720624000 | Victoria Ahles | Family Medicine | 619 S Washington St, Moscow, ID 83843-3090 | 2019-11-21 |
| 1083043327 | Courtney Tanner | Massage Therapist | 619 S Washington St, Moscow, ID 83843-3090 | 2013-11-07 |
| 1083042048 | Lori Reynolds | Massage Therapist | 619 S Washington St, Moscow, ID 83843-3090 | 2013-10-29 |
| 1699103317 | Rachael Marlene Monroe | Massage Therapist | 619 S Washington St, Ste 101, Moscow, ID 83843-3090 | 2013-10-15 |
| 1346689783 | Danielle Marie Watson | Specialist | 619 S Washington St, Ste 202, Moscow, ID 83843-3090 | 2013-06-19 |
| 1730466616 | Paradise Creek Counseling and Consulting | Counselor | 619 S Washington St, Suite 301, Moscow, ID 83843-3090 | 2011-11-07 |
| 1932412103 | Palouse-clearwater Neurology, P.a. | Psychiatry & Neurology | 619 S Washington St, Suite 201, Moscow, ID 83843-3090 | 2010-07-16 |
| 1205011889 | Palouse Foot & Ankle Clinic | Durable Medical Equipment & Medical Supplies | 619 S Washington St, 103, Moscow, ID 83843-3090 | 2008-01-02 |
| 1043492655 | Total Health Physician Group LLC | Family Medicine | 619 S Washington St, Suite 203, Moscow, ID 83843-3090 | 2007-12-05 |
| 1891918629 | Drue O. Wagner | Family Medicine | 619 S Washington St, Suite 203, Moscow, ID 83843-3090 | 2007-04-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033726880 | Moscow Physical Therapy, LLC | Clinic/Center | 1174 Alturas Drive, Suite 2, Moscow, ID 83843 | 2020-09-25 |
| 1831703057 | Hydee Flishaw Tubbs Becker | Dietitian, Registered | 614 North Hayes Street, Moscow, ID 83843 | 2020-09-04 |
| 1528626959 | Ryan Steven Clark | Student in an Organized Health Care Education/Training Program | 212 Farm Road, #201, Moscow, ID 83843 | 2019-05-31 |
| 1770141384 | Lingwen Zhang | Specialist/Technologist | 901 Paradise Creek Rd, Moscow, ID 83843 | 2019-05-30 |
| 1306363478 | Elizabeth Campbell | Dietitian, Registered | 611 S. Main, Moscow, ID 83843 | 2017-08-29 |
| 1598285496 | Gina Cretser | Counselor | 212 Rodeo Dr. #410, Moscow, ID 83843 | 2017-06-21 |
| 1124558721 | Morgan Leigh Derloshon | Specialist/Technologist | 275 Southview Ave, Apt 206, Moscow, ID 83843 | 2017-06-15 |
| 1619411790 | Kaylene Howard | Massage Therapist | 127 South Washington, Suite 6, Moscow, ID 83843 | 2016-12-08 |
| 1407237043 | Jacob Kent Christensen | Family Medicine | 831 S Ash St, Moscow, ID 83843 | 2015-06-09 |
| 1366851388 | Elisabeth Henry | Pharmacist | 2740 West Pullman Rd, Moscow, ID 83843 | 2014-08-04 |
| Find all providers in zip 83843 | ||||
| Taxonomy Code | 213ES0103X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| Specialization | Foot & Ankle Surgery |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518225929 | Clark A Johnson | Podiatrist | 3120 W Belltower Dr Ste 100, Meridian, ID 83646-7744 | 2012-04-24 |
| 1396023446 | Kurt Earl Kinghorn | Podiatrist | 1828 S Millenium Way Ste 200, Meridian, ID 83642-5036 | 2011-07-22 |
| 1649506536 | James Rex Cutler | Podiatrist | 76 E 1st S, Rexburg, ID 83440-1936 | 2009-10-27 |
| 1174756316 | Daniel Matthew Wettstein | Podiatrist | 476 Cheney Drive West, Twin Falls, ID 83301 | 2009-09-03 |
| 1578576732 | Bruce G Tolman | Podiatrist | 1540 Elk Creek Dr, Idaho Falls, ID 83404-8322 | 2006-08-15 |
| 1679514186 | Ryan Averett Dpm PC | Podiatrist | 2221 W Ironwood Center Dr, Coeur D Alene, ID 83814-2697 | 2006-06-08 |
| 1245216647 | Kert W Howard | Podiatrist | 1555 E Clark St, Pocatello, ID 83201-4133 | 2005-12-16 |
| 1093717787 | Richard Michael Allen | Podiatrist | 1630 23rd Ave, Suite 1001, Lewiston, ID 83501-6350 | 2005-08-11 |
| 1326042045 | Michael J Drager | Podiatrist | 850 W Ironwood Dr, Ste 301, Coeur D Alene, ID 83814-4903 | 2005-06-09 |
| 1083261697 | Treasure Valley Foot and Ankle | Podiatrist | 3120 W Belltower Dr Ste 100, Meridian, ID 83646-7744 | 2019-08-20 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.