Healthcare Provider Details

I. General information

NPI: 1346321783
Provider Name (Legal Business Name): HERBERT LEE WILLIAMS II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1292 WAIANUENUE AVE
HILO HI
96720-1228
US

IV. Provider business mailing address

1292 WAIANUENUE AVE
HILO HI
96720-1228
US

V. Phone/Fax

Practice location:
  • Phone: 808-934-4000
  • Fax:
Mailing address:
  • Phone: 808-934-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD-5211
License Number StateHI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier069849-02
Identifier TypeMEDICAID
Identifier StateHI
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: