Healthcare Provider Details

I. General information

NPI: 1720177652
Provider Name (Legal Business Name): JAMES H GOLLOP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 01/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 MOHOULI STREET
HILO HI
96720
US

IV. Provider business mailing address

PO BOX 857
HILO HI
96721-0857
US

V. Phone/Fax

Practice location:
  • Phone: 808-969-3051
  • Fax: 808-969-3728
Mailing address:
  • Phone: 808-969-3051
  • Fax: 808-969-3728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberMD5667
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: