Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | MD 10118 | HI |
NPI | 1427002468 |
---|---|
Provider Name | Dr. George Andrew Rourke |
First Address | Hilo, HI 96720-4530 |
Second Address | Hilo, HI 96720-4530 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A70772 | (02) | HI |