Provider Demographics
NPI:1528386299
Name:DAVID M HUNTLEY MD INC
Entity Type:Organization
Organization Name:DAVID M HUNTLEY MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:HUNTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-261-2700
Mailing Address - Street 1:407 ULUNIU ST
Mailing Address - Street 2:#314
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2519
Mailing Address - Country:US
Mailing Address - Phone:808-261-2700
Mailing Address - Fax:808-263-8513
Practice Address - Street 1:407 ULUNIU ST
Practice Address - Street 2:#314
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2519
Practice Address - Country:US
Practice Address - Phone:808-261-2700
Practice Address - Fax:808-263-8513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-05
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD2753207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIHDF273AMedicare PIN