Provider Demographics
NPI:1063442960
Name:FANCHER, DONALD C (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:C
Last Name:FANCHER
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 1:148 KAWIKA PL
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-5006
Mailing Address - Country:US
Mailing Address - Phone:808-547-4600
Mailing Address - Fax:
Practice Address - Street 1:280 HOMEOLU PLACE
Practice Address - Street 2:
Practice Address - City:KAUNAKAKAI
Practice Address - State:HI
Practice Address - Zip Code:96748
Practice Address - Country:US
Practice Address - Phone:808-553-5331
Practice Address - Fax:808-553-3133
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD1815207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI031547Medicaid
HI031547Medicaid
H56183Medicare ID - Type Unspecified