Healthcare Provider Details

I. General information

NPI: 1134341365
Provider Name (Legal Business Name): MARTIN L CROW IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4725 BOUGAINVILLE DR
HONOLULU HI
96818-3179
US

IV. Provider business mailing address

PO BOX 2788
EWA BEACH HI
96706-0788
US

V. Phone/Fax

Practice location:
  • Phone: 619-944-8598
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: