Healthcare Provider Details

I. General information

NPI: 1437255080
Provider Name (Legal Business Name): ROBERT J. BIDWELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 08/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 PUNAHOU ST
HONOLULU HI
96826-1001
US

IV. Provider business mailing address

1319 PUNAHOU ST SUITE 715
HONOLULU HI
96826-1001
US

V. Phone/Fax

Practice location:
  • Phone: 808-983-8387
  • Fax: 808-945-1570
Mailing address:
  • Phone: 808-983-8387
  • Fax: 808-945-1570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberMD-5297
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: