Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 9701763 | NC |
Y | 208000000X | Pediatrician | MD14428 | HI |
N | 2080P0203X | Pediatric Critical Care Doctor | 4880 | SD |
N | 2080P0205X | Pediatric Endocrinologist | 11963 | NV |
NPI | 1215985320 |
---|---|
Provider Name | Edwin P. Herd |
First Address | Kailua-Kona, HI 96740 |
Second Address | Kailua-Kona, HI 96740 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 14/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002019516 | (05) | NV |
613100 | (05) | HI |
6701490 | (05) | SD |
891113Q | (05) | NC |
G20192 | (02) |