Provider Demographics
NPI:1073811758
Name:JAMES PANETTA, DO, PLLC
Entity Type:Organization
Organization Name:JAMES PANETTA, DO, PLLC
Other - Org Name:WINDWARD DIGESTIVE HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:DANNY
Authorized Official - Last Name:PANETTA
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:808-440-6789
Mailing Address - Street 1:642 ULUKAHIKI ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-4400
Mailing Address - Country:US
Mailing Address - Phone:808-440-6789
Mailing Address - Fax:808-440-6777
Practice Address - Street 1:642 ULUKAHIKI ST
Practice Address - Street 2:SUITE 302
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-4400
Practice Address - Country:US
Practice Address - Phone:808-440-6789
Practice Address - Fax:808-440-6777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-04
Last Update Date:2013-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4543207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIGV865ZMedicare PIN