=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215985320
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EDWIN P. HERD MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2006
-----------------------------------------------------
Last Update Date | 04/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 78-6831 ALI'I DRIVE SUITE 328
-----------------------------------------------------
City | KAILUA-KONA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96740
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-747-8321
-----------------------------------------------------
Fax | 808-322-2502
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 78-6831 ALI'I DRIVE SUITE 328
-----------------------------------------------------
City | KAILUA-KONA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96740
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-747-8321
-----------------------------------------------------
Fax | 808-331-8682
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | MD14428
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 9701763
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 2080P0203X
-----------------------------------------------------
Taxonomy Name | Pediatric Critical Care Medicine Physician
-----------------------------------------------------
License Number | 4880
-----------------------------------------------------
License Number State | SD
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 2080P0205X
-----------------------------------------------------
Taxonomy Name | Pediatric Endocrinology Physician
-----------------------------------------------------
License Number | 11963
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | ME167424
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------