Healthcare Provider Details

I. General information

NPI: 1285695940
Provider Name (Legal Business Name): PETER RICHARD HURLBUT-MILLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 09/09/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 ALA MOANA BLVD STE 500
HONOLULU HI
96815-1437
US

IV. Provider business mailing address

1620 ALA MOANA BLVD STE 500
HONOLULU HI
96815-1437
US

V. Phone/Fax

Practice location:
  • Phone: 808-955-0255
  • Fax: 808-955-4155
Mailing address:
  • Phone: 808-955-0255
  • Fax: 808-955-4155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD21900
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number7029008-1205
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberMD21900
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: