MEDICARE: MR. JOSEPH DAVID MATTHEWS III IDC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1710I1002X	Independent Duty Corpsman

General Provider Information

NPI Number	:	1760444681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH DAVID MATTHEWS III IDC

Provider Business Mailing Address
First Line	:	1430 MORTON ST BLDG 619
Second Line	:
City	:	PEARL HARBOR
State	:	HI
Zip	:	96860-4664
Country	:	US
Telephone Number	:	808-473-1479
Fax Number	:

Provider Business Practice Location Address
First Line	:	4711 NEVADA ST
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96818-5071
Country	:	US
Telephone Number	:	808-744-2510
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	10/17/2008

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