Provider Demographics
NPI:1235334947
Name:MATSUO, LEON (MD)
Entity Type:Individual
Prefix:
First Name:LEON
Middle Name:
Last Name:MATSUO
Suffix:
Gender:M
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:PO BOX 312
Mailing Address - Street 2:
Mailing Address - City:CAPTAIN COOK
Mailing Address - State:HI
Mailing Address - Zip Code:96704-0312
Mailing Address - Country:US
Mailing Address - Phone:808-825-6557
Mailing Address - Fax:
Practice Address - Street 1:82-6066 MAMALAHOA HWY STE 14
Practice Address - Street 2:
Practice Address - City:CAPTAIN COOK
Practice Address - State:HI
Practice Address - Zip Code:96704-8204
Practice Address - Country:US
Practice Address - Phone:808-825-6557
Practice Address - Fax:808-731-6511
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-16101208000000X, 207R00000X, 208000000X, 207R00000X
AZ43927208000000X
AZ81272208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics