Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 170100000X | Medical Geneticist | 3863 | MT |
Y | 207Q00000X | Family Doctor | MD-14631 | HI |
NPI | 1649290545 |
---|---|
Provider Name | Glenn M Shiotani |
First Address | Wailuku, HI 96793-2416 |
Second Address | Wailuku, HI 96793-2416 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 11/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000277376 | HMSA BILLING NUMBER (01) | HI |
620361-02 | (05) | HI |
C63991 | (02) | MT |