Provider Demographics
NPI:1891709200
Name:CAPEL, CHRISTOPHER CONRAD (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:CONRAD
Last Name:CAPEL
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:PO BOX 1410
Mailing Address - Street 2:ATTN: CHRISTOPHER CAPEL
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38935-1410
Mailing Address - Country:US
Mailing Address - Phone:662-459-7189
Mailing Address - Fax:662-459-1147
Practice Address - Street 1:501 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-4237
Practice Address - Country:US
Practice Address - Phone:662-453-4641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA44466208600000X
AZ37937208600000X
MS15299208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ4942607OtherCIGNA
WA8415952Medicaid
AZ305844Medicaid
WA8853375Medicare PIN
AZ4942607OtherCIGNA
F95133Medicare UPIN