Provider Demographics
NPI:1023192275
Name:JAHRAUS, TIMOTHY C (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:C
Last Name:JAHRAUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:497 KAMAHAO WAY
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-1570
Mailing Address - Country:US
Mailing Address - Phone:808-937-5171
Mailing Address - Fax:808-935-7657
Practice Address - Street 1:134 PUUHONU WAY
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2067
Practice Address - Country:US
Practice Address - Phone:808-935-1956
Practice Address - Fax:808-935-7657
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD 6551174400000X
HI6551207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00C005927-3OtherQUEST HMSA
HI198057OtherHMA
HI05186401Medicaid
HIC5927-3OtherHMSA
HI100003154OtherRAIL ROAD MEDICARE