Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | MD-10667 | HI |
NPI | 1013087303 |
---|---|
Provider Name | Dr. Robert T. Mathis |
First Address | Lihue, HI 96766-1098 |
Second Address | Lihue, HI 96766-1098 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2006 |
Last Update Date | 04/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000256610 | HMSA (01) | HI |
285356 | UHA (01) | HI |
575350 01 | (05) | HI |
I47069 | (02) | HI |