Healthcare Provider Details

I. General information

NPI: 1508830258
Provider Name (Legal Business Name): ROBERT J MEDOFF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 AULIKE ST SUITE 506
KAILUA HI
96734-2739
US

IV. Provider business mailing address

30 AULIKE ST SUITE 506
KAILUA HI
96734-2739
US

V. Phone/Fax

Practice location:
  • Phone: 808-261-4658
  • Fax: 808-263-2036
Mailing address:
  • Phone: 808-261-4658
  • Fax: 808-263-2036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD4076
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: