Healthcare Provider Details

I. General information

NPI: 1598719916
Provider Name (Legal Business Name): ROBERT L. PETERSON, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 PUNAHOU ST #1070
HONOLULU HI
96826-1001
US

IV. Provider business mailing address

1319 PUNAHOU ST #1070
HONOLULU HI
96826-1001
US

V. Phone/Fax

Practice location:
  • Phone: 808-944-8557
  • Fax: 808-955-5667
Mailing address:
  • Phone: 808-944-8557
  • Fax: 808-955-5667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMD7087
License Number StateHI

VIII. Authorized Official

Name: MR. ROBERT L PETERSON
Title or Position: OWNER
Credential: M.D.
Phone: 808-944-8551