Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 10939 | TX |
NPI | 1043661895 |
---|---|
Provider Name | Jefferey L Fiame |
First Address | Tripler Amc, HI 96859-5000 |
Second Address | Tripler Amc, HI 96859-5000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2016 |
Last Update Date | 23/06/2016 |