Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | DOS759 | HI |
NPI | 1194831537 |
---|---|
Provider Name | Dr. Christopher D Brace |
First Address | Honolulu, HI 96813-2524 |
Second Address | Honolulu, HI 96825-3405 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
07569003 | (05) | HI |
F79112 | (02) | HI |