Provider Demographics
NPI:1770660581
Name:WATANABE, GERALD H (MD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:H
Last Name:WATANABE
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 1:321 N KUAKINI ST
Mailing Address - Street 2:SUITE 802
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-2362
Mailing Address - Country:US
Mailing Address - Phone:808-529-8801
Mailing Address - Fax:808-529-8803
Practice Address - Street 1:321 N KUAKINI ST
Practice Address - Street 2:SUITE 802
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-2362
Practice Address - Country:US
Practice Address - Phone:808-529-8801
Practice Address - Fax:808-529-8803
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD7651207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI048553-01Medicaid
HIH0000BDZDRMedicare ID - Type Unspecified
HIF57780Medicare UPIN