Provider Demographics
NPI:1679555866
Name:ETCUBANEZ, EDWIN F (MD)
Entity type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:F
Last Name:ETCUBANEZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2100 KANOELEHUA AVE
Mailing Address - Street 2:B9
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-6500
Mailing Address - Country:US
Mailing Address - Phone:808-981-1700
Mailing Address - Fax:808-981-1701
Practice Address - Street 1:2100 KANOELEHUA AVE
Practice Address - Street 2:B9
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-6500
Practice Address - Country:US
Practice Address - Phone:808-981-1700
Practice Address - Fax:808-981-1701
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2013-09-10
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Provider Licenses
StateLicense IDTaxonomies
MI4301045023207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI540Z90298OtherHEALTH PLUS
MI0800900422OtherBLUE CROSS BLUE SHIELD
MI1009100OtherHEALTH ADVANTAGE NETWORK
MI080D410020OtherCOMMUNITY BLUE
MI080D410020OtherBLUE CARE NETWORK
MI1009110OtherMCLAREN HEALTH PLAN
MI4395680Medicaid
MI080D410020OtherBLUE CROSS BLUE SHIELD
MID72564OtherHEALTH NET FEDERAL SERVIC
MI4433932Medicaid
MI4433932Medicaid
MID72564Medicare UPIN