Healthcare Provider Details

I. General information

NPI: 1053406538
Provider Name (Legal Business Name): GORDAN J TROCKMAN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 N KALAHEO AVENUE SUITE A102
KAILUA HI
96734
US

IV. Provider business mailing address

820 MILILANI STREET SUITE 702A
HONOLULU HI
96813
US

V. Phone/Fax

Practice location:
  • Phone: 808-254-6484
  • Fax: 808-254-6427
Mailing address:
  • Phone: 808-523-9363
  • Fax: 808-523-9418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD2980
License Number StateHI

VIII. Authorized Official

Name: GORDON J TROCKMAN
Title or Position: OWNER
Credential: MD
Phone: 808-523-9363