=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447661293
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALFRED A. INES, MD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2014
-----------------------------------------------------
Last Update Date | 05/14/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 94-216 FARRINGTON HWY SUITE B2-305; BOX 334
-----------------------------------------------------
City | WAIPAHU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96797-1922
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-671-8877
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 94-216 FARRINGTON HWY SUITE B2-305; BOX 334
-----------------------------------------------------
City | WAIPAHU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96797-1922
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-671-8877
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ALFRED A. INES
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 808-753-4553
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 6077
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------