Healthcare Provider Details

I. General information

NPI: 1447257076
Provider Name (Legal Business Name): BRADLEY JOHN CAPAWANA DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DR. BRAD CAPAWANA

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 SE BISHOP BLVD STE 140
PULLMAN WA
99163-5517
US

IV. Provider business mailing address

825 SE BISHOP BLVD STE 201
PULLMAN WA
99163-5517
US

V. Phone/Fax

Practice location:
  • Phone: 509-334-4498
  • Fax: 509-339-7324
Mailing address:
  • Phone: 509-334-4498
  • Fax: 509-334-0380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberP-159
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO00000638
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: