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General NPI Number Information
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NPI Number | 1669438842
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Entity Type | Individual
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Provider Name | ANTONIN JAROS MD
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Gender | Male
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Dates
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Enumeration Date | 04/25/2006
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Last Update Date | 04/06/2019
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Provider Practice Location Address
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Address Line | 105 MAUI LANI PKWY STE 100
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City | WAILUKU
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State | HI
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Zip | 96793-2443
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Country | US
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Telephone | 480-740-2106
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Fax |
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Provider Business Mailing Address
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Address Line | 105 MAUI LANI PKWY STE 100
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City | WAILUKU
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State | HI
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Zip | 96793-2443
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Country | US
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Telephone | 480-740-2106
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 31852
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 19943
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License Number State | HI
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