MEDICARE: DR. ROBERT GRIES M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QG0300X	Geriatric Medicine (Family Medicine) Physician	MD12058	HI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669425906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT GRIES M.D.

Provider Business Mailing Address
First Line	:	PO BOX 700309
Second Line	:
City	:	KAPOLEI
State	:	HI
Zip	:	96709-0309
Country	:	US
Telephone Number	:	808-393-3230
Fax Number	:	808-356-1335

Provider Business Practice Location Address
First Line	:	6163 SUMMER ST
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96821-2342
Country	:	US
Telephone Number	:	808-393-3230
Fax Number	:	808-356-1335

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	10/20/2021

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