Provider Demographics
NPI:1043208549
Name:VINCENT, JUDY MAKOWSKI (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:MAKOWSKI
Last Name:VINCENT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 PAUAHILANI PL
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-3147
Mailing Address - Country:US
Mailing Address - Phone:808-263-4788
Mailing Address - Fax:
Practice Address - Street 1:154 PAUAHILANI PL
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-3147
Practice Address - Country:US
Practice Address - Phone:808-263-4788
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD 11835208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics