Provider Demographics
NPI:1770833360
Name:DON T. MATSUURA, M.D., INC.
Entity Type:Organization
Organization Name:DON T. MATSUURA, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DON
Authorized Official - Middle Name:T
Authorized Official - Last Name:MATSUURA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-935-0056
Mailing Address - Street 1:1248 KINOOLE ST STE 104
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4171
Mailing Address - Country:US
Mailing Address - Phone:808-935-0056
Mailing Address - Fax:808-961-3061
Practice Address - Street 1:1248 KINOOLE ST STE 104
Practice Address - Street 2:
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:808-961-3061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-11
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD - 4599174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIC-98517Medicare UPIN