Provider Demographics
NPI:1730197369
Name:CAPEK, PAVEL (MD)
Entity type:Individual
Prefix:DR
First Name:PAVEL
Middle Name:
Last Name:CAPEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 E 32ND ST
Mailing Address - Street 2:PATHOLOGY - LABORATORY
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-7251
Mailing Address - Country:US
Mailing Address - Phone:505-538-4056
Mailing Address - Fax:505-574-4992
Practice Address - Street 1:1313 E 32ND ST
Practice Address - Street 2:PATHOLOGY - LABORATORY
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-7251
Practice Address - Country:US
Practice Address - Phone:505-538-4056
Practice Address - Fax:505-574-4992
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM99-22207ZP0102X
TXK9746207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMZ8174Medicaid
NMG94244Medicare UPIN