Provider Demographics
NPI:1821149402
Name:HILL, BRENTON (DO)
Entity Type:Individual
Prefix:DR
First Name:BRENTON
Middle Name:
Last Name:HILL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2ND BATTALLION 3RD MARINES
Mailing Address - Street 2:PO BOX 63012
Mailing Address - City:KANEOHE BAY
Mailing Address - State:HI
Mailing Address - Zip Code:96863-3012
Mailing Address - Country:US
Mailing Address - Phone:808-257-3419
Mailing Address - Fax:
Practice Address - Street 1:1354 MILOIKI ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96825-3223
Practice Address - Country:US
Practice Address - Phone:808-754-0522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDOS-1040208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice