Provider Demographics
NPI:1669507331
Name:MAUI DERMATOLOGY
Entity Type:Organization
Organization Name:MAUI DERMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MARSHALL
Authorized Official - Last Name:KNOX
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:808-875-7477
Mailing Address - Street 1:375 HUKU LII PL
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-8996
Mailing Address - Country:US
Mailing Address - Phone:808-875-7477
Mailing Address - Fax:808-879-4585
Practice Address - Street 1:375 HUKU LII PL
Practice Address - Street 2:SUITE 201
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-8996
Practice Address - Country:US
Practice Address - Phone:808-875-7477
Practice Address - Fax:808-879-4585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-12517174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00A0247906OtherHMSA
HI00B0247904OtherHMSA
HI00A0247906OtherHMSA
HI00B0247904OtherHMSA