Provider Demographics
NPI:1093828840
Name:ATEBARA, NEAL H (MD, FACS)
Entity Type:Individual
Prefix:
First Name:NEAL
Middle Name:H
Last Name:ATEBARA
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 LUSITANA ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2421
Mailing Address - Country:US
Mailing Address - Phone:808-550-8440
Mailing Address - Fax:808-550-8488
Practice Address - Street 1:1380 LUSITANA ST
Practice Address - Street 2:SUITE 201
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2421
Practice Address - Country:US
Practice Address - Phone:808-550-8440
Practice Address - Fax:808-550-8488
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD 9729174400000X
HIMD9729207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI08089302Medicaid
HIA210904OtherHMSA
HI08089302Medicaid
HIA210904OtherHMSA