Provider Demographics
NPI:1639299696
Name:SAUNDERS, GORDON WALTER (MD)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:WALTER
Last Name:SAUNDERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11087
Mailing Address - Street 2:
Mailing Address - City:LAHAINA
Mailing Address - State:HI
Mailing Address - Zip Code:96761-1087
Mailing Address - Country:US
Mailing Address - Phone:808-667-9721
Mailing Address - Fax:808-661-1584
Practice Address - Street 1:2435 KAANAPALI PKWY
Practice Address - Street 2:SUITE H7
Practice Address - City:LAHAINA
Practice Address - State:HI
Practice Address - Zip Code:96761-1980
Practice Address - Country:US
Practice Address - Phone:808-667-9721
Practice Address - Fax:808-661-1584
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD10004208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIBAZMANMedicare ID - Type UnspecifiedGROUP NUMBER
HI50898Medicare ID - Type UnspecifiedPROVIDER BILLING NUMBER
HIG74831Medicare UPIN