1205831864 NPI number — R. CRAIG NETZER M.D.

Table of content: R. CRAIG NETZER M.D. (NPI 1205831864)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205831864 NPI number — R. CRAIG NETZER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NETZER
Provider First Name:
R. CRAIG
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205831864
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/05/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4473 PAHEE ST STE L
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIHUE
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96766-2037
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-632-0200
Provider Business Mailing Address Fax Number:
808-632-0201

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4473 PAHEE ST
Provider Second Line Business Practice Location Address:
STE O
Provider Business Practice Location Address City Name:
LIHUE
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96766-2037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-246-2709
Provider Business Practice Location Address Fax Number:
808-246-2700
Provider Enumeration Date:
06/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  MD-11719 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 50101602 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com