Provider Demographics
NPI:1396816567
Name:FESTERLING, BUDDY KARL (MD)
Entity Type:Individual
Prefix:
First Name:BUDDY
Middle Name:KARL
Last Name:FESTERLING
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 1:73 PUUHONU PL
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2060
Mailing Address - Country:US
Mailing Address - Phone:808-969-7922
Mailing Address - Fax:808-934-2059
Practice Address - Street 1:73 PUUHONU PL
Practice Address - Street 2:SUITE 200
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2060
Practice Address - Country:US
Practice Address - Phone:808-969-7922
Practice Address - Fax:808-934-2059
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD - 10056207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIF94980Medicare UPIN