Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | MD-3964 | HI |
NPI | 1013012533 |
---|---|
Provider Name | Dr. Robert J. Conrad |
First Address | Lihue, HI 96766-1098 |
Second Address | Lihue, HI 96766-1098 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2006 |
Last Update Date | 08/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C97363 | (02) | HI |