Healthcare Provider Details

I. General information

NPI: 1346408820
Provider Name (Legal Business Name): CLAYTON AUSTIN EVERLINE MD, FACP, FAWM, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98-1079 MOANALUA RD STE 610
AIEA HI
96701-4716
US

IV. Provider business mailing address

98-1079 MOANALUA RD STE 610
AIEA HI
96701-4716
US

V. Phone/Fax

Practice location:
  • Phone: 808-488-9250
  • Fax: 808-486-3740
Mailing address:
  • Phone: 808-488-9250
  • Fax: 808-486-3740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License NumberMD432642
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number252471
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number25MA08368700
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License NumberMD15206
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: