Healthcare Provider Details

I. General information

NPI: 1316033574
Provider Name (Legal Business Name): HUGH SCOTT MOORE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/01/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5371 KOLOA ROAD
KOLOA HI
96756
US

IV. Provider business mailing address

3-3420 KUHIO HWY STE B
LIHUE HI
96766-1098
US

V. Phone/Fax

Practice location:
  • Phone: 808-742-1621
  • Fax: 808-742-1592
Mailing address:
  • Phone: 808-245-1504
  • Fax: 808-246-1363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD-23541
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: