Individual
DR. MATTHEW B. TETERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
55 MAUI LANI PKWY, WAILUKU, HI 96793-2416
(808) 243-6050
Mailing address
55 MAUI LANI PKWY, WAILUKU, HI 96793-2416
(808) 243-6050
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
01058871A
IN
207Q00000X
Family Medicine Physician
Primary
MD-22200
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200487590
—
IN
01
—
236040ZZZZ
MEDICARE PTAN
IN
Enumeration date
12/01/2005
Last updated
07/20/2022
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