Healthcare Provider Details

I. General information

NPI: 1609394543
Provider Name (Legal Business Name): HUNTER ROBERT EDWIN WARNER LAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2017
Last Update Date: 08/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 KALANIANAOLE HWY
KAILUA HI
96734-4600
US

IV. Provider business mailing address

56 PARK AVE
WESTERLY RI
02891-1948
US

V. Phone/Fax

Practice location:
  • Phone: 401-222-9662
  • Fax:
Mailing address:
  • Phone: 401-222-9662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number001074
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: