Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | MD-20864 | HI |
Y | 207ND0101X | MOHS-Micrographic Surgeon | MD-20864 | HI |
NPI | 1194112391 |
---|---|
Provider Name | Dr. Ethan Thacher Routt |
First Address | Honolulu, HI 96817-1605 |
Second Address | Honolulu, HI 96817-1605 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2015 |
Last Update Date | 02/10/2020 |