Healthcare Provider Details

I. General information

NPI: 1366449605
Provider Name (Legal Business Name): DILWORTH THOMAS ROGERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 12/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 KAMEHAMEHA AVE. SUITE A
KAHULUI HI
96732-2263
US

IV. Provider business mailing address

39 KAMEHAMEHA AVE. SUITE A
KAHULUI HI
96732-2263
US

V. Phone/Fax

Practice location:
  • Phone: 808-877-7078
  • Fax: 808-871-4702
Mailing address:
  • Phone: 808-877-7078
  • Fax: 808-871-4702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD 10291
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: