Healthcare Provider Details

I. General information

NPI: 1871156950
Provider Name (Legal Business Name): ANDREW JACKSON WYERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MAHALANI ST
WAILUKU HI
96793-2547
US

IV. Provider business mailing address

400 MAHALANI ST
WAILUKU HI
96793-2547
US

V. Phone/Fax

Practice location:
  • Phone: 808-244-5555
  • Fax:
Mailing address:
  • Phone: 808-244-5555
  • Fax: 808-244-5557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number23465
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberT7396
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberR77396
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code207PH0002X
TaxonomyHospice and Palliative Medicine (Emergency Medicine) Physician
License Number23465
License Number StateHI
# 5
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberT7396
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: