Healthcare Provider Details

I. General information

NPI: 1083548440
Provider Name (Legal Business Name): JASON MATTHEW TIMMERMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 PAA ST
HONOLULU HI
96819-4405
US

IV. Provider business mailing address

2828 PAA ST
HONOLULU HI
96819-4405
US

V. Phone/Fax

Practice location:
  • Phone: 833-833-3333
  • Fax:
Mailing address:
  • Phone: 833-833-3333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMDR9241
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: