Healthcare Provider Details

I. General information

NPI: 1861422032
Provider Name (Legal Business Name): TORREY LYNCH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 08/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 WAIANUENUE AVE
HILO HI
96720-2020
US

IV. Provider business mailing address

2109 KAIWIKI RD
HILO HI
96720-9722
US

V. Phone/Fax

Practice location:
  • Phone: 808-433-5077
  • Fax:
Mailing address:
  • Phone: 808-772-2339
  • Fax: 808-772-2339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number01057690A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number252923-1
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number15761
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: