Provider Demographics
NPI:1164422986
Name:MEYER, BERNARD C (MD)
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:C
Last Name:MEYER
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 1:110 PIIMAUNA ST
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-8868
Mailing Address - Country:US
Mailing Address - Phone:808-264-4107
Mailing Address - Fax:808-533-1482
Practice Address - Street 1:110 PIIMAUNA ST
Practice Address - Street 2:
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768-8868
Practice Address - Country:US
Practice Address - Phone:808-264-4107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-5970207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI49716601Medicaid
HI49716601Medicaid