Basic Information
| Provider Information | |||||||||
| NPI: | 1811416050 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAPOUANO | ||||||||
| FirstName: | MAX | ||||||||
| MiddleName: | LEON | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1722 PINE ST STE 203 | ||||||||
| Address2: | |||||||||
| City: | MONTGOMERY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 361061158 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3342938736 | ||||||||
| FaxNumber: | 3342938738 | ||||||||
| Practice Location | |||||||||
| Address1: | 1801 PINE ST STE 301 | ||||||||
| Address2: | |||||||||
| City: | MONTGOMERY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 361061154 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3342655577 | ||||||||
| FaxNumber: | 3342655584 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2017 | ||||||||
| LastUpdateDate: | 12/14/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD.41620 | AL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.