Provider Demographics
NPI:1851334551
Name:SMITH, DOUGLAS L (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:L
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1188 BISHOP ST
Mailing Address - Street 2:SUITE 3007
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-3312
Mailing Address - Country:US
Mailing Address - Phone:808-599-3922
Mailing Address - Fax:808-599-8612
Practice Address - Street 1:1188 BISHOP ST
Practice Address - Street 2:SUITE 3007
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-3312
Practice Address - Country:US
Practice Address - Phone:808-599-3922
Practice Address - Fax:808-599-8612
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HIMD43052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000004390OtherHAWAII MEDICAL SVC ASSN
HI00509201Medicaid
HI0000004390OtherHAWAII MEDICAL SVC ASSN
HI00509201Medicaid