Provider Demographics
NPI:1598106247
Name:DAMIEN TAVARES MD, LLC
Entity Type:Organization
Organization Name:DAMIEN TAVARES MD, LLC
Other - Org Name:HAWAII PAIN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAMIEN
Authorized Official - Middle Name:KEKANEINOA
Authorized Official - Last Name:TAVARES
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:808-445-9172
Mailing Address - Street 1:2226 LILIHA ST
Mailing Address - Street 2:SUITE 407
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-1600
Mailing Address - Country:US
Mailing Address - Phone:808-445-9172
Mailing Address - Fax:808-445-9182
Practice Address - Street 1:2226 LILIHA ST
Practice Address - Street 2:SUITE 407
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-1600
Practice Address - Country:US
Practice Address - Phone:808-445-9172
Practice Address - Fax:808-445-9182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-10
Last Update Date:2016-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD15987261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIHK059AMedicare PIN