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General NPI Number Information
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NPI Number | 1104544501
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Entity Type | Individual
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Provider Name | DR. MARK GRIPP
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Gender | Male
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Dates
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Enumeration Date | 08/22/2022
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Last Update Date | 08/22/2022
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Provider Practice Location Address
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Address Line | 711 KAPIOLANI BLVD STE 200
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City | HONOLULU
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State | HI
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Zip | 96813-6028
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Country | US
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Telephone | 403-594-1883
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Fax |
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Provider Business Mailing Address
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Address Line | 46-157 NAHIKU PL
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City | KANEOHE
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State | HI
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Zip | 96744-3625
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Country | US
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Telephone | 403-594-1883
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MED-PHYS-LIC-114091
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License Number State | MT
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