Healthcare Provider Details

I. General information

NPI: 1306032180
Provider Name (Legal Business Name): GARY B. PITT DPM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2007
Last Update Date: 09/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59-229 ALAPIO RD
HALEIWA HI
96712-9604
US

IV. Provider business mailing address

59-229 ALAPIO RD
HALEIWA HI
96712-9604
US

V. Phone/Fax

Practice location:
  • Phone: 808-638-7589
  • Fax:
Mailing address:
  • Phone: 808-638-7589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO136
License Number StateHI

VIII. Authorized Official

Name: DR. GARY BYRON PITT
Title or Position: PRESIDENT
Credential: DPM
Phone: 808-638-7589