Provider Demographics
NPI:1033384011
Name:WILLIAMS, DOUG MARLIS (PA)
Entity Type:Individual
Prefix:
First Name:DOUG
Middle Name:MARLIS
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:642 ULUKAHIKI ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-4400
Mailing Address - Country:US
Mailing Address - Phone:808-263-3233
Mailing Address - Fax:808-263-3220
Practice Address - Street 1:1051 KEOLU DR STE 107
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-3800
Practice Address - Country:US
Practice Address - Phone:808-263-3233
Practice Address - Fax:808-263-3220
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15136363AM0700X
HIAMD536363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical