Provider Demographics
NPI:1356438964
Name:DAVID L. CAPACCIO DO, PLLC
Entity type:Organization
Organization Name:DAVID L. CAPACCIO DO, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:CAPACCIO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:520-297-1131
Mailing Address - Street 1:1980 W HOSPITAL DR
Mailing Address - Street 2:SUITE 309
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-7802
Mailing Address - Country:US
Mailing Address - Phone:520-297-1131
Mailing Address - Fax:520-297-2023
Practice Address - Street 1:1980 W HOSPITAL DR
Practice Address - Street 2:SUITE 309
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-7802
Practice Address - Country:US
Practice Address - Phone:520-297-1131
Practice Address - Fax:520-297-2023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4118207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ101168Medicare PIN