Healthcare Provider Details

I. General information

NPI: 1174819049
Provider Name (Legal Business Name): JONATHAN A CAPPEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2011
Last Update Date: 02/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1940 STONEGATE DR STE 130
VESTAVIA HLS AL
35242-2541
US

IV. Provider business mailing address

1940 STONEGATE DR STE 130
VESTAVIA HLS AL
35242-2541
US

V. Phone/Fax

Practice location:
  • Phone: 205-977-9876
  • Fax: 205-977-9976
Mailing address:
  • Phone: 205-977-9876
  • Fax: 205-977-9976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number55234
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number34133
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberMD.34133
License Number StateAL
# 5
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number34133
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: