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General NPI Number Information
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NPI Number | 1194975516
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Entity Type | Organization
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Legal Business Name | BRIAN I. WATANABE, M.D., INC.
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Dates
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Enumeration Date | 09/22/2008
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Last Update Date | 09/22/2008
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Provider Practice Location Address
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Address Line | 1885 MAIN ST SUITE 205
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City | WAILUKU
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State | HI
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Zip | 96793-1819
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Country | US
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Telephone | 808-244-6776
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Fax | 808-244-6005
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Provider Business Mailing Address
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Address Line | PO BOX 308
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City | WAILUKU
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State | HI
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Zip | 96793-0308
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Country | US
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Telephone | 808-244-6776
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Fax | 808-244-6005
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Authorized Official
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Title or Position | PRESIDENT / OWNER
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Name | DR. BRIAN I. WATANABE
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Credential | M.D.
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Telephone | 808-244-6776
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD-7581
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | MD-7581
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License Number State | HI
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