Healthcare Provider Details

I. General information

NPI: 1275510653
Provider Name (Legal Business Name): RAY E BROGGINI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45-549 PLUMERIA ST HAMAKUA HEALTH CENTER INC
HONOKAA HI
96727-6902
US

IV. Provider business mailing address

PO BOX 12
KAMUELA HI
96743-0012
US

V. Phone/Fax

Practice location:
  • Phone: 808-775-7204
  • Fax: 808-775-9404
Mailing address:
  • Phone: 808-775-1051
  • Fax: 808-775-1051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD12192
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: