Healthcare Provider Details

I. General information

NPI: 1699859314
Provider Name (Legal Business Name): PATRICIA L. BORMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAT BORMAN MD

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 05/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

642 ULUKAHIKI ST STE 300
KAILUA HI
96734-4439
US

IV. Provider business mailing address

642 ULUKAHIKI STREET #300
KAILUA HI
96734-4439
US

V. Phone/Fax

Practice location:
  • Phone: 808-261-4476
  • Fax: 808-263-4476
Mailing address:
  • Phone: 808-261-4476
  • Fax: 808-263-4476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD17866
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: