Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | PO-168 | HI |
Y | 222Z00000X | Podiatrist | PO-168 | HI |
NPI | 1033113071 |
---|---|
Provider Name | Douglas K Birch |
First Address | Kahului, HI 96732-2348 |
Second Address | Kahului, HI 96732-2348 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2005 |
Last Update Date | 30/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
54589001 | (05) | HI |
U98384 | (02) | HI |