Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 01239 | HI |
N | 2080P0205X | Pediatric Endocrinologist | 01239 | HI |
NPI | 1386608214 |
---|---|
Provider Name | Mr. Sorrell Harold Waxman |
First Address | Honolulu, HI 96826-1001 |
Second Address | Honolulu, HI 96826-1001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00125301 | (05) | HI |
C98981 | (02) | HI |