Healthcare Provider Details

I. General information

NPI: 1629035613
Provider Name (Legal Business Name): JANE B SERVICE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 PUNAHOU ST SUITE 510
HONOLULU HI
96826-1001
US

IV. Provider business mailing address

1319 PUNAHOU ST SUITE 510
HONOLULU HI
96826-1001
US

V. Phone/Fax

Practice location:
  • Phone: 808-942-8411
  • Fax: 808-949-2720
Mailing address:
  • Phone: 808-942-8411
  • Fax: 808-949-2720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMD4910
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: