Provider Demographics
NPI:1619279767
Name:JOHN C PURTZER D O INC
Entity Type:Organization
Organization Name:JOHN C PURTZER D O INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:PURTZER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:808-533-1711
Mailing Address - Street 1:1188 BISHOP ST
Mailing Address - Street 2:SUITE 3202
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-3301
Mailing Address - Country:US
Mailing Address - Phone:808-533-1711
Mailing Address - Fax:808-537-3125
Practice Address - Street 1:1188 BISHOP ST
Practice Address - Street 2:SUITE 3202
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-3301
Practice Address - Country:US
Practice Address - Phone:808-533-1711
Practice Address - Fax:808-537-3125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-23
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDOS 4372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000048819OtherHAWAII MEDICAL SERVICE ASSOCIATION
HI04368002Medicaid
HI04368002Medicaid
HI0000LCBCMMedicare PIN