Provider Demographics
NPI:1306081336
Name:MATSUURA, RUTH HASE (MD)
Entity type:Individual
Prefix:DR
First Name:RUTH
Middle Name:HASE
Last Name:MATSUURA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RUTH
Other - Middle Name:H
Other - Last Name:MATSUURA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:P.O. BOX 1004
Mailing Address - Street 2:RUTH H. MATSUURA M.D.
Mailing Address - City:KURTISTOWN
Mailing Address - State:HI
Mailing Address - Zip Code:96760
Mailing Address - Country:US
Mailing Address - Phone:808-968-7471
Mailing Address - Fax:
Practice Address - Street 1:17-40 34 ENOS ROAD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:HI
Practice Address - Zip Code:96771
Practice Address - Country:US
Practice Address - Phone:808-968-7471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2242208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIG01798Medicaid