Healthcare Provider Details

I. General information

NPI: 1164422986
Provider Name (Legal Business Name): BERNARD C. MEYER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 PIIMAUNA ST
MAKAWAO HI
96768-8868
US

IV. Provider business mailing address

110 PIIMAUNA ST
MAKAWAO HI
96768-8868
US

V. Phone/Fax

Practice location:
  • Phone: 808-264-4107
  • Fax:
Mailing address:
  • Phone: 808-264-4107
  • Fax: 808-533-1482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD-5970
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: