Provider Demographics
NPI:1114010709
Name:BACLIG, GODOFREDO BARCENA (MD)
Entity Type:Individual
Prefix:DR
First Name:GODOFREDO
Middle Name:BARCENA
Last Name:BACLIG
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 1:405 N KUAKINI ST
Mailing Address - Street 2:SUITE 1112
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-6300
Mailing Address - Country:US
Mailing Address - Phone:808-524-5024
Mailing Address - Fax:808-524-5715
Practice Address - Street 1:405 N KUAKINI ST
Practice Address - Street 2:SUITE 1112
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-6300
Practice Address - Country:US
Practice Address - Phone:808-524-5024
Practice Address - Fax:808-524-5715
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI8967207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00203001Medicaid
HI021234-0OtherHMSA PROVIDER NUMBER
HI00203001Medicaid