Healthcare Provider Details

I. General information

NPI: 1871573626
Provider Name (Legal Business Name): PETER RP DONNELLY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95-390 KUAHELANI AVE
MILILANI HI
96789
US

IV. Provider business mailing address

128 LEHUA ST
WAHIAWA HI
96786
US

V. Phone/Fax

Practice location:
  • Phone: 808-627-3200
  • Fax: 808-623-7872
Mailing address:
  • Phone: 808-621-8411
  • Fax: 808-621-4117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD10133
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: