Basic Information
| Provider Information | |||||||||
| NPI: | 1174819049 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAPPEL | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1940 STONEGATE DR STE 130 | ||||||||
| Address2: | |||||||||
| City: | VESTAVIA HLS | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352422541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059779876 | ||||||||
| FaxNumber: | 2059779976 | ||||||||
| Practice Location | |||||||||
| Address1: | 1940 STONEGATE DR STE 130 | ||||||||
| Address2: | |||||||||
| City: | VESTAVIA HLS | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352422541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059779876 | ||||||||
| FaxNumber: | 2059779976 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2011 | ||||||||
| LastUpdateDate: | 02/08/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 55234 | MN | N | Allopathic & Osteopathic Physicians | Dermatology | 207ND0101X | 34133 | AL | N | Allopathic & Osteopathic Physicians | Dermatology | MOHS-Micrographic Surgery | 207NS0135X | MD.34133 | AL | N | Allopathic & Osteopathic Physicians | Dermatology | Procedural Dermatology | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207NS0135X | 34133 | AL | Y | Allopathic & Osteopathic Physicians | Dermatology | Procedural Dermatology |
No ID Information.