Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD4255 | HI |
N | 2080P0214X | Pediatric Pulmonologist | MD4255 | HI |
NPI | 1619078615 |
---|---|
Provider Name | Dr. Wallace J Matthews JR. |
First Address | Honolulu, HI 96814-2009 |
Second Address | Honolulu, HI 96814-2009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000004481 | QHMS (01) | HI |
00519101 | (05) | HI |
00519101 | QALC (01) | HI |
04481 | HMSA (01) | HI |
192509 | HMAI (01) | HI |
C98518 | (02) | HI |
J4489 | HMSA (01) | HI |
MD4255-01 | QHCP (01) | HI |