Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081P2900X | Pain Medicine | MD15987 | HI |
NPI | 1194921619 |
---|---|
Provider Name | Dr. Damien Kekaneinoa Tavares III |
First Address | Honolulu, HI 96817-1600 |
Second Address | Honolulu, HI 96817-1600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2007 |
Last Update Date | 27/07/2015 |