Provider Demographics
NPI:1508073586
Name:DAVIES, MATTHEW C (DO)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:C
Last Name:DAVIES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1292 WAIANUENUE AVE
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-1228
Mailing Address - Country:US
Mailing Address - Phone:808-934-4000
Mailing Address - Fax:
Practice Address - Street 1:1292 WAIANUENUE AVE
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-1228
Practice Address - Country:US
Practice Address - Phone:808-934-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2009-01-07
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2008-11-07
Provider Licenses
StateLicense IDTaxonomies
CAD12345207PE0004X
HIDOS 1202207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI626369-02Medicaid
HI0000280743OtherHMSA BILLING NUMBER
HI0000280743OtherHMSA BILLING NUMBER