Provider Demographics
NPI:1316922024
Name:CAPOS, JOHN KARL (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:KARL
Last Name:CAPOS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 655
Mailing Address - Street 2:
Mailing Address - City:MOUNT SHASTA
Mailing Address - State:CA
Mailing Address - Zip Code:96067-0655
Mailing Address - Country:US
Mailing Address - Phone:775-857-8090
Mailing Address - Fax:530-918-6039
Practice Address - Street 1:620 S MOUNT SHASTA BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT SHASTA
Practice Address - State:CA
Practice Address - Zip Code:96067-2530
Practice Address - Country:US
Practice Address - Phone:530-918-6037
Practice Address - Fax:530-918-6039
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR7P11207Q00000X
CA20A9753207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine