Provider Demographics
NPI:1760917926
Name:PETER A MATSUURA, MD
Entity Type:Organization
Organization Name:PETER A MATSUURA, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MATSUURA
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:808-969-3331
Mailing Address - Street 1:670 PONAHAWAI ST STE 214
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-7830
Mailing Address - Country:US
Mailing Address - Phone:808-969-3331
Mailing Address - Fax:808-935-6175
Practice Address - Street 1:670 PONAHAWAI ST STE 214
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-7830
Practice Address - Country:US
Practice Address - Phone:808-969-3331
Practice Address - Fax:808-935-6175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-9105207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI076295Medicaid
HI203794OtherHMSA
HI203794OtherHMSA
HIF49461Medicare UPIN
HI1134710001Medicare NSC