Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 3865 | HI |
NPI | 1114106036 |
---|---|
Provider Name | John Thomas Mcdonnell |
First Address | Kaneohe, HI 96744-3788 |
Second Address | Kaneohe, HI 96744-3788 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2007 |
Last Update Date | 02/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003310-01 | (05) | HI |
H0000BDHXF | (02) | HI |