1629034582 NPI number — DR. J. GREGORY TURNBULL PSYD

Table of content: DR. J. GREGORY TURNBULL PSYD (NPI 1629034582)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629034582 NPI number — DR. J. GREGORY TURNBULL PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TURNBULL
Provider First Name:
J.
Provider Middle Name:
GREGORY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSYD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TURNBULL
Provider Other First Name:
JAMES
Provider Other Middle Name:
GREGORY
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PSYD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1629034582
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/15/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
603 PAOPUA LOOP
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KAILUA
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96734-3535
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-398-8666
Provider Business Mailing Address Fax Number:
888-527-8662

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
603 PAOPUA LOOP
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KAILUA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96734-3535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-398-8666
Provider Business Practice Location Address Fax Number:
888-527-8662
Provider Enumeration Date:
04/20/2006

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: 103T00000X , with the licence number:  PSY 929 , 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: 58194301 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0000258160 . This is a "BCBS HAWAII HAWAII MEDICAL SERVICES ASSOCIATION (HMSA)" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".