Healthcare Provider Details

I. General information

NPI: 1255471470
Provider Name (Legal Business Name): BRUCE ARMIN GOTTLEBER SOLL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 LUSITANA ST STE 704
HONOLULU HI
96813-2431
US

IV. Provider business mailing address

606 HUNAKAI ST
HONOLULU HI
96816-4910
US

V. Phone/Fax

Practice location:
  • Phone: 808-524-2100
  • Fax:
Mailing address:
  • Phone: 808-732-1972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD2211
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: