Provider Demographics
NPI:1508830258
Name:MEDOFF, ROBERT J (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:MEDOFF
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:30 AULIKE ST
Mailing Address - Street 2:SUITE 506
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2739
Mailing Address - Country:US
Mailing Address - Phone:808-261-4658
Mailing Address - Fax:808-263-2036
Practice Address - Street 1:30 AULIKE ST
Practice Address - Street 2:SUITE 506
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2739
Practice Address - Country:US
Practice Address - Phone:808-261-4658
Practice Address - Fax:808-263-2036
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2024-01-03
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Provider Licenses
StateLicense IDTaxonomies
HIMD4076207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIMD407601OtherQUEENS QUEST
HI020547-01Medicaid
HI4390580001OtherDMERC
HI00A0022705OtherHMSA
HI00A0022705OtherBLUE CROSS
HI197302100OtherDEPT OF LABOR FEDERAL