Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 13964 | HI |
N | 207R00000X | Internist | 13964 | HI |
N | 111NI0900X | Internist | 13964 | HI |
NPI | 1336210061 |
---|---|
Provider Name | Dr. Vance Laidlaw Fletcher |
First Address | Ewa Beach, HI 96706-3607 |
Second Address | Ewa Beach, HI 96706-3607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 23/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I20339 | (02) |