Provider Demographics
NPI:1760444681
Name:MATTHEWS, JOSEPH DAVID III (IDC)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:DAVID
Last Name:MATTHEWS
Suffix:III
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 MORTON ST BLDG 619
Mailing Address - Street 2:
Mailing Address - City:PEARL HARBOR
Mailing Address - State:HI
Mailing Address - Zip Code:96860-4664
Mailing Address - Country:US
Mailing Address - Phone:808-473-1479
Mailing Address - Fax:
Practice Address - Street 1:4711 NEVADA ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96818-5071
Practice Address - Country:US
Practice Address - Phone:808-744-2510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman