Healthcare Provider Details

I. General information

NPI: 1851334551
Provider Name (Legal Business Name): DOUGLAS L SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1188 BISHOP ST SUITE 3007
HONOLULU HI
96813-3312
US

IV. Provider business mailing address

1188 BISHOP ST SUITE 3007
HONOLULU HI
96813-3312
US

V. Phone/Fax

Practice location:
  • Phone: 808-599-3922
  • Fax: 808-599-8612
Mailing address:
  • Phone: 808-599-3922
  • Fax: 808-599-8612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD4305
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: