1578702007 NPI number — LAWRENCE DERBES MD INC.

Table of content: (NPI 1578702007)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578702007 NPI number — LAWRENCE DERBES MD INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAWRENCE DERBES MD INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1578702007
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
64-1032 MAMALAHOA HWY
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
KAMUELA
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96743-8441
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-333-5303
Provider Business Mailing Address Fax Number:
808-339-7425

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
64-1032 MAMALAHOA HWY
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
KAMUELA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96743-8441
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-333-5303
Provider Business Practice Location Address Fax Number:
808-339-7425
Provider Enumeration Date:
02/05/2009

Additional Information

Authorized Official

Authorized Official Last Name:
DERBES
Authorized Official First Name:
LAWRENCE
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
808-954-1327

Provider Taxonomy Codes

  • Taxonomy code: 207RI0011X , with the licence number:  MD12544 , 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)





Copyright © 2007-2025 www.npivalidator.com