Provider Demographics
NPI:1699829127
Name:BAYSA, ELMER F (MD)
Entity Type:Individual
Prefix:
First Name:ELMER
Middle Name:F
Last Name:BAYSA
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 1:91-775 PAPIPI RD
Mailing Address - Street 2:#A
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
Practice Address - Street 2:#A
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
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-4889207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIC1679-4OtherHMSA
HI01561901Medicaid
HIH0000BDLCPMedicare PIN
HIC1679-4OtherHMSA