=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104841790
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PATRICK K. OKAMURA M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 79-1019 HAUKAPILA ST
-----------------------------------------------------
City | KEALAKEKUA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96750-7920
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-547-9593
-----------------------------------------------------
Fax | 808-599-2714
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 75-5783 MELELINA ST
-----------------------------------------------------
City | KAILUA KONA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96740-1929
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-329-6136
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207PE0004X
-----------------------------------------------------
Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
-----------------------------------------------------
License Number | MD2261
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------