Healthcare Provider Details

I. General information

NPI: 1700047339
Provider Name (Legal Business Name): RANDOLPH HUTTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2008
Last Update Date: 04/05/2024
Certification Date: 04/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91-2135 FORT WEAVER RD FL 3
EWA BEACH HI
96706-1940
US

IV. Provider business mailing address

91-2135 FORT WEAVER RD FL 3
EWA BEACH HI
96706-1940
US

V. Phone/Fax

Practice location:
  • Phone: 808-691-3340
  • Fax:
Mailing address:
  • Phone: 808-691-3340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number132816
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number260186
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD-21912
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: