Basic Information
| Provider Information | |||||||||
| NPI: | 1568641306 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | CAPOUYA | ||||||||
| FirstName: | JARED | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 CHILDREN'S WAY | ||||||||
| Address2: | SLOT 844 | ||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722023500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5013642090 | ||||||||
| FaxNumber: | 5013643929 | ||||||||
| Practice Location | |||||||||
| Address1: | 315 MARTIN LUTHER KING JR WAY | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984054234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534034538 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/29/2007 | ||||||||
| LastUpdateDate: | 08/19/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | E11708 | AR | Y | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | MD00048960 | WA | N | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.