Provider Demographics
NPI:1053368373
Name:MATSUURA, PETER ARNOLD (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:ARNOLD
Last Name:MATSUURA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:670 PONAHAWAI ST
Mailing Address - Street 2:SUITE 214
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2660
Mailing Address - Country:US
Mailing Address - Phone:808-969-3331
Mailing Address - Fax:808-935-6175
Practice Address - Street 1:670 PONAHAWAI ST
Practice Address - Street 2:SUITE 214
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2660
Practice Address - Country:US
Practice Address - Phone:808-969-3331
Practice Address - Fax:808-935-6175
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-9105207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI7629501Medicaid
HIF49461Medicare UPIN
HI7629501Medicaid
HI1134710001Medicare NSC