1104994201 NPI number — DR. PETER HALFORD MD

Table of content: DR. PETER HALFORD MD (NPI 1104994201)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104994201 NPI number — DR. PETER HALFORD MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALFORD
Provider First Name:
PETER
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1104994201
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1329 LUSITANA
Provider Second Line Business Mailing Address:
706
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96813
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-536-1107
Provider Business Mailing Address Fax Number:
808-536-2931

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1329 LUSITANA
Provider Second Line Business Practice Location Address:
706
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-536-1107
Provider Business Practice Location Address Fax Number:
808-536-2931
Provider Enumeration Date:
11/30/2006

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: 208600000X , with the licence number:  2135 , 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: MD2135 . This is a "MDX 1991" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 00A0039105 . This is a "HMSA 1991" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 03540801 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".




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