Provider Demographics
NPI:1083794986
Name:JOHN S SPANGLER MD LLC
Entity Type:Organization
Organization Name:JOHN S SPANGLER MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SPANGLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-791-7844
Mailing Address - Street 1:1100 WARD AVE STE 701
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1617
Mailing Address - Country:US
Mailing Address - Phone:808-791-7844
Mailing Address - Fax:808-791-7844
Practice Address - Street 1:1100 WARD AVE STE 701
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1617
Practice Address - Country:US
Practice Address - Phone:808-791-7844
Practice Address - Fax:808-791-7844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2236174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH57544Medicare ID - Type Unspecified