Healthcare Provider Details

I. General information

NPI: 1801186549
Provider Name (Legal Business Name): ISLAND ORTHOPAEDICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2011
Last Update Date: 12/21/2020
Certification Date: 12/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3382 WAIALAE AVE
HONOLULU HI
96816-2637
US

IV. Provider business mailing address

3382 WAIALAE AVE
HONOLULU HI
96816-2637
US

V. Phone/Fax

Practice location:
  • Phone: 808-548-7033
  • Fax:
Mailing address:
  • Phone: 808-548-7033
  • Fax: 808-548-7034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number16009
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number14577
License Number StateHI

VIII. Authorized Official

Name: DR. ALEXANDER CHARLES GARBER
Title or Position: OWNER
Credential: MD, PHD
Phone: 808-548-7033