Healthcare Provider Details

I. General information

NPI: 1053424887
Provider Name (Legal Business Name): JOSEPH W. BURRIS JR. M.D., MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 08/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2585 WAHO ST
KOLOA HI
96756-9550
US

IV. Provider business mailing address

2585 WAHO ST
KOLOA HI
96756-9550
US

V. Phone/Fax

Practice location:
  • Phone: 808-346-3324
  • Fax:
Mailing address:
  • Phone: 808-346-3324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA94008
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number14727
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: