Healthcare Provider Details

I. General information

NPI: 1881194363
Provider Name (Legal Business Name): JEFFREY LAWRENCE WAKE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2018
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JARRETT WHITE RD
TRIPLER AMC HI
96859-5001
US

IV. Provider business mailing address

1 JARRETT WHITE RD
TRIPLER AMC HI
96859-5001
US

V. Phone/Fax

Practice location:
  • Phone: 808-433-3557
  • Fax: 808-433-5806
Mailing address:
  • Phone: 808-433-3557
  • Fax: 808-481-5507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberDOS-2183
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: