Provider Demographics
NPI:1720184120
Name:MATSUURA, DON TOSHIO (MD)
Entity Type:Individual
Prefix:DR
First Name:DON
Middle Name:TOSHIO
Last Name:MATSUURA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1061 KUAHIWI PLACE
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4092
Mailing Address - Country:US
Mailing Address - Phone:808-961-2061
Mailing Address - Fax:808-961-3061
Practice Address - Street 1:1248 KINOOLE ST
Practice Address - Street 2:STE 104
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4171
Practice Address - Country:US
Practice Address - Phone:808-935-0056
Practice Address - Fax:808-969-7886
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDEA AM2097435207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
013839Medicare ID - Type Unspecified
C98517Medicare UPIN