Healthcare Provider Details

I. General information

NPI: 1972676450
Provider Name (Legal Business Name): JEFF T HEALY MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98-1079 MOANALUA RD SUITE 590
AIEA HI
96701-4713
US

IV. Provider business mailing address

98-1079 MOANALUA RD SUITE 590
AIEA HI
96701-4713
US

V. Phone/Fax

Practice location:
  • Phone: 808-487-0076
  • Fax: 808-485-4593
Mailing address:
  • Phone: 808-487-0076
  • Fax: 808-485-4593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number12346
License Number StateHI

VIII. Authorized Official

Name: DR. JEFF T HEALY
Title or Position: PRESIDENT
Credential: MD
Phone: 808-487-0076