Provider Demographics
NPI:1578610168
Name:ALQUERO, EDWARD A (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:A
Last Name:ALQUERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:EDUARDO
Other - Middle Name:A
Other - Last Name:ALQUERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:94-141 PUPUPUHI ST
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-2510
Mailing Address - Country:US
Mailing Address - Phone:808-676-2271
Mailing Address - Fax:
Practice Address - Street 1:94-141 PUPUPUHI ST
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-2510
Practice Address - Country:US
Practice Address - Phone:808-676-2271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD5541207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI021988-01Medicaid
HI54427Medicare PIN
HI021988-01Medicaid