Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 17804 | HI |
Y | 2080N0001X | Neonatal-Perinatal Doctor | 17804 | HI |
NPI | 1043500721 |
---|---|
Provider Name | Dr. Robert Jonathan Mccully |
First Address | Tripler Army Medical Center, HI 96859-5001 |
Second Address | Tripler Army Medical Center, HI 96859-5001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2011 |
Last Update Date | 12/06/2017 |