Healthcare Provider Details

I. General information

NPI: 1033118971
Provider Name (Legal Business Name): DAVID MARVIN WOODLIFF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 02/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75-5751 KUAKINI HWY STE 203
KAILUA KONA HI
96740-1752
US

IV. Provider business mailing address

75-5751 KUAKINI HWY STE 203
KAILUA KONA HI
96740-1752
US

V. Phone/Fax

Practice location:
  • Phone: 808-326-5629
  • Fax:
Mailing address:
  • Phone: 808-326-5629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDW029464
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: