Healthcare Provider Details

I. General information

NPI: 1669425906
Provider Name (Legal Business Name): ROBERT GRIES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 10/20/2021
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6163 SUMMER ST
HONOLULU HI
96821-2342
US

IV. Provider business mailing address

PO BOX 700309
KAPOLEI HI
96709-0309
US

V. Phone/Fax

Practice location:
  • Phone: 808-393-3230
  • Fax: 808-356-1335
Mailing address:
  • Phone: 808-393-3230
  • Fax: 808-356-1335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberMD12058
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: