Provider Demographics
NPI:1316012289
Name:R. CRAIG NETZER MD INC
Entity Type:Organization
Organization Name:R. CRAIG NETZER MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:NETZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-246-2002
Mailing Address - Street 1:4473 PAHEE ST
Mailing Address - Street 2:STE L
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-2037
Mailing Address - Country:US
Mailing Address - Phone:808-632-0200
Mailing Address - Fax:808-632-0201
Practice Address - Street 1:4473 PAHEE ST
Practice Address - Street 2:STE O
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-2037
Practice Address - Country:US
Practice Address - Phone:808-246-2002
Practice Address - Fax:808-246-2700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD11719207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI50101602Medicaid
HIHMSA BC HAWAIIOther00A0232684
HIH57578Medicare PIN
HIH65103Medicare UPIN