Healthcare Provider Details

I. General information

NPI: 1376568527
Provider Name (Legal Business Name): DAVID M HUNTLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 ULUNIU ST #314
KAILUA HI
96734-2519
US

IV. Provider business mailing address

407 ULUNIU ST #314
KAILUA HI
96734-2519
US

V. Phone/Fax

Practice location:
  • Phone: 808-261-2700
  • Fax: 808-263-8513
Mailing address:
  • Phone: 808-261-2700
  • Fax: 808-263-8513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number2753
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: