Provider Demographics
NPI:1609805878
Name:KAPSTAFER, KENNARD JOSEPH (MD)
Entity Type:Individual
Prefix:MR
First Name:KENNARD
Middle Name:JOSEPH
Last Name:KAPSTAFER
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 1:105 W 8TH AVE
Mailing Address - Street 2:STE. 418
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2302
Mailing Address - Country:US
Mailing Address - Phone:509-747-3081
Mailing Address - Fax:509-455-8462
Practice Address - Street 1:105 W 8TH AVE
Practice Address - Street 2:STE. 418
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2302
Practice Address - Country:US
Practice Address - Phone:509-747-3081
Practice Address - Fax:509-455-8462
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00009403208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1066315Medicaid
WA349502Medicare ID - Type Unspecified
WA1066315Medicaid