Provider Demographics
NPI:1619456035
Name:ELMER F. BAYSA MD, INC
Entity Type:Organization
Organization Name:ELMER F. BAYSA MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:VALENCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-689-8315
Mailing Address - Street 1:91-775 PAPIPI RD STE A
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-2466
Mailing Address - Country:US
Mailing Address - Phone:808-689-8315
Mailing Address - Fax:808-689-8153
Practice Address - Street 1:91-775 PAPIPI RD STE A
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-2466
Practice Address - Country:US
Practice Address - Phone:808-689-8315
Practice Address - Fax:808-689-8153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-4889207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty