Provider Demographics
NPI:1396549283
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:ALICE
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:
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?:Yes
Parent Organization LBN:PETER A MATSUURA MD ORTHOPAEDIC SURGERY & SPORTS MEDICINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty