Provider Demographics
NPI:1194921619
Name:TAVARES, DAMIEN KEKANEINOA III (MD)
Entity type:Individual
Prefix:DR
First Name:DAMIEN
Middle Name:KEKANEINOA
Last Name:TAVARES
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:2226 LILIHA STREET
Mailing Address - Street 2:SUITE 407
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-1600
Mailing Address - Country:US
Mailing Address - Phone:808-445-9172
Mailing Address - Fax:808-445-9182
Practice Address - Street 1:2226 LILIHA STREET
Practice Address - Street 2:SUITE 407
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-1600
Practice Address - Country:US
Practice Address - Phone:808-445-9172
Practice Address - Fax:808-445-9182
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2015-07-27
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Provider Licenses
StateLicense IDTaxonomies
HIMD15987208VP0014X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI46-2530807OtherTIN