Basic Information
| Provider Information | |||||||||
| NPI: | 1194998997 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAPRILES | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | EDWARD | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1739 E BEVERLY AVE | ||||||||
| Address2: | STE. 200 | ||||||||
| City: | KINGMAN | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 864093593 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9282634547 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3104 N STOCKTON HILL RD | ||||||||
| Address2: | MOHAVE SURGICAL SPECIALISTS | ||||||||
| City: | KINGMAN | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 864014183 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9286818720 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2008 | ||||||||
| LastUpdateDate: | 04/22/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 43714 | AZ | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 43714 | 01 | AZ | AZ LICENSE | OTHER | 001623 | 01 | GA | PHYSICIAN, GENERAL SURGER | OTHER | 555715 | 05 | AZ | MEDICAID |