Provider Demographics
NPI:1639233448
Name:TAFOYA, MARK E (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:E
Last Name:TAFOYA
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 1:94-849 LUMIAINA ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-5025
Mailing Address - Country:US
Mailing Address - Phone:808-676-4772
Mailing Address - Fax:808-676-8772
Practice Address - Street 1:94-849 LUMIAINA ST
Practice Address - Street 2:SUITE 102
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-5025
Practice Address - Country:US
Practice Address - Phone:808-676-4772
Practice Address - Fax:808-676-8772
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-11913207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000237289OtherHMSA BILLING NUMBER
HI517724-01Medicaid
HIH21352Medicare UPIN
HI0000237289OtherHMSA BILLING NUMBER