Healthcare Provider Details

I. General information

NPI: 1861536021
Provider Name (Legal Business Name): BARRON D. ELLEBY D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 04/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 DAIRY RD STE D
KAHULUI HI
96732-2348
US

IV. Provider business mailing address

415 DAIRY RD STE D
KAHULUI HI
96732-2348
US

V. Phone/Fax

Practice location:
  • Phone: 808-877-3668
  • Fax: 808-877-3248
Mailing address:
  • Phone: 808-877-3668
  • Fax: 808-877-3248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO-224
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPOD001069
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: