Provider Demographics
NPI:1881794402
Name:MAGOUN, THATCHER NMN VI (MD)
Entity type:Individual
Prefix:DR
First Name:THATCHER
Middle Name:NMN
Last Name:MAGOUN
Suffix:VI
Gender:M
Credentials:MD
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Mailing Address - Street 1:3781 PAPALINA RD
Mailing Address - Street 2:
Mailing Address - City:KALAHEO
Mailing Address - State:HI
Mailing Address - Zip Code:96741-9513
Mailing Address - Country:US
Mailing Address - Phone:808-332-9430
Mailing Address - Fax:808-332-9430
Practice Address - Street 1:3781 PAPALINA RD
Practice Address - Street 2:
Practice Address - City:KALAHEO
Practice Address - State:HI
Practice Address - Zip Code:96741-9513
Practice Address - Country:US
Practice Address - Phone:808-332-9430
Practice Address - Fax:808-332-9430
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
HI1601208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIC97492Medicare UPIN