Healthcare Provider Details

I. General information

NPI: 1902907058
Provider Name (Legal Business Name): JAMES MCKOY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 10/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 PAA ST
HONOLULU HI
96819-4405
US

IV. Provider business mailing address

2828 PAA ST
HONOLULU HI
96819-4405
US

V. Phone/Fax

Practice location:
  • Phone: 808-432-7450
  • Fax:
Mailing address:
  • Phone: 808-432-7450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberMD-6813
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberMD-6813
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: