Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 043947 | CT |
Y | 207Q00000X | Family Doctor | MD-18804 | HI |
NPI | 1003844465 |
---|---|
Provider Name | John G Meisel |
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 | 28/06/2006 |
Last Update Date | 19/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001439472 | (05) | CT |
H66357 | (02) | CT |