Healthcare Provider Details

I. General information

NPI: 1346342029
Provider Name (Legal Business Name): JAMES L WINKLER PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 OKA ST
KILAUEA HI
96754-5308
US

IV. Provider business mailing address

2460 OKA ST
KILAUEA HI
96754-5308
US

V. Phone/Fax

Practice location:
  • Phone: 808-828-2885
  • Fax: 808-828-0119
Mailing address:
  • Phone: 808-828-2885
  • Fax: 808-828-0119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberAMD-67
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: