Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | A78934 | CA |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | MD-11324 | HI |
NPI | 1023197159 |
---|---|
Provider Name | Peter V. Mathews |
First Address | Honolulu, HI 96814-2118 |
Second Address | Honolulu, HI 96814-2118 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 30/06/2021 |