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General NPI Number Information
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NPI Number | 1659772762
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Entity Type | Organization
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Legal Business Name | BIG ISLAND UROLOGY & ANDROLOGY
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Dates
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Enumeration Date | 09/08/2014
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Last Update Date | 09/08/2014
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Provider Practice Location Address
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Address Line | 75-184 HUALALAI RD STE 200
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City | KAILUA KONA
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State | HI
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Zip | 96740-1719
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Country | US
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Telephone | 808-238-0412
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Fax | 808-238-0427
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Provider Business Mailing Address
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Address Line | 75-184 HUALALAI RD STE 200
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City | KAILUA KONA
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State | HI
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Zip | 96740-1719
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Country | US
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Telephone | 808-238-0412
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Fax | 808-238-0427
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MRS. BEONKA J SNYDER
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Credential |
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Telephone | 808-238-0412
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | MD-14791
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License Number State | HI
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