Healthcare Provider Details

I. General information

NPI: 1548577836
Provider Name (Legal Business Name): RODNEY GEORGE BJORDAHL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 09/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 MAHALANI ST
WAILUKU HI
96793
US

IV. Provider business mailing address

P.O. BOX 1937
WAILUKU HI
96793
US

V. Phone/Fax

Practice location:
  • Phone: 808-243-3085
  • Fax: 808-442-5067
Mailing address:
  • Phone: 808-243-3085
  • Fax: 808-442-5067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDOS-353
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: