Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | G70630 | CA |
Y | 207QA0505X | Family Doctor - Adult Medicine | 6796 | HI |
NPI | 1083607626 |
---|---|
Provider Name | Malcolm Macdonald |
First Address | Kamuela, HI 96743-8441 |
Second Address | Kamuela, HI 96743-8496 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2005 |
Last Update Date | 25/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E34725 | (02) | CA |