MEDICARE: DR. BRADLEY JOHN CAPAWANA DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	P-159	ID
2	213ES0103X	Foot & Ankle Surgery Podiatrist	PO00000638	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447257076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRADLEY JOHN CAPAWANA DPM

Provider Business Mailing Address
First Line	:	825 SE BISHOP BLVD STE 201
Second Line	:
City	:	PULLMAN
State	:	WA
Zip	:	99163-5517
Country	:	US
Telephone Number	:	509-334-4498
Fax Number	:	509-334-0380

Provider Business Practice Location Address
First Line	:	825 SE BISHOP BLVD STE 140
Second Line	:
City	:	PULLMAN
State	:	WA
Zip	:	99163-5517
Country	:	US
Telephone Number	:	509-334-4498
Fax Number	:	509-339-7324

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	07/09/2025

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Directions to “ DR. BRADLEY JOHN CAPAWANA DPM” Practice Location

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