Provider Demographics
NPI:1578702007
Name:LAWRENCE DERBES MD INC.
Entity Type:Organization
Organization Name:LAWRENCE DERBES MD INC.
Other - Org Name:ISLAND HEART AND VASCULAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:DERBES
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:808-954-1327
Mailing Address - Street 1:64-1032 MAMALAHOA HWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-8441
Mailing Address - Country:US
Mailing Address - Phone:808-333-5303
Mailing Address - Fax:808-339-7425
Practice Address - Street 1:64-1032 MAMALAHOA HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-8441
Practice Address - Country:US
Practice Address - Phone:808-333-5303
Practice Address - Fax:808-339-7425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-05
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD12544207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty