Healthcare Provider Details

I. General information

NPI: 1336179167
Provider Name (Legal Business Name): ROBERT DAILEY IRVINE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 09/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 PONAHAWAI ST SUITE 115
HILO HI
96720-2660
US

IV. Provider business mailing address

670 PONAHAWAI ST SUITE 115
HILO HI
96720-2660
US

V. Phone/Fax

Practice location:
  • Phone: 808-935-5465
  • Fax: 808-935-5467
Mailing address:
  • Phone: 808-935-5465
  • Fax: 808-935-5467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2284
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: