Provider Demographics
NPI:1164409546
Name:POWER, JAMES T III (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:T
Last Name:POWER
Suffix:III
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:PO BOX 682
Mailing Address - Street 2:
Mailing Address - City:KAPAAU
Mailing Address - State:HI
Mailing Address - Zip Code:96755-0682
Mailing Address - Country:US
Mailing Address - Phone:808-884-5190
Mailing Address - Fax:808-884-5196
Practice Address - Street 1:280 HOMEOLU PLACE
Practice Address - Street 2:
Practice Address - City:KAUNAKAKAI
Practice Address - State:HI
Practice Address - Zip Code:96748-0408
Practice Address - Country:US
Practice Address - Phone:808-553-3141
Practice Address - Fax:808-553-3140
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD6345207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI51864901Medicaid
121813OtherMEDICARE FQHC
E50821Medicare UPIN
HI51864901Medicaid