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General NPI Number Information
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NPI Number | 1740836733
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Entity Type | Organization
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Legal Business Name | J EDWARD DEBOARD MD LLC
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Dates
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Enumeration Date | 08/14/2019
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Last Update Date | 08/14/2019
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Provider Practice Location Address
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Address Line | 1329 LUSITANA ST STE 102
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City | HONOLULU
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State | HI
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Zip | 96813-2401
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Country | US
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Telephone | 808-533-1020
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Fax |
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Provider Business Mailing Address
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Address Line | 1342 ALOHA OE DR
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City | KAILUA
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State | HI
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Zip | 96734-4508
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Country | US
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Telephone | 808-741-5646
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Fax |
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Authorized Official
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Title or Position | AGENT
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Name | JOHN DEBOARD
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Credential | MD
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Telephone | 808-741-5646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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