=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619279767
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOHN C PURTZER D O INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/23/2010
-----------------------------------------------------
Last Update Date | 12/08/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1188 BISHOP ST SUITE 3202
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96813-3301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-533-1711
-----------------------------------------------------
Fax | 808-537-3125
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1188 BISHOP ST SUITE 3202
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96813-3301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-533-1711
-----------------------------------------------------
Fax | 808-537-3125
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JOHN C PURTZER
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 808-533-1711
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | DOS 437
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------