Provider Demographics
NPI:1902844533
Name:PLOWMAN, GARY LEE (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:LEE
Last Name:PLOWMAN
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 3089
Mailing Address - Street 2:
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-6089
Mailing Address - Country:US
Mailing Address - Phone:808-245-7871
Mailing Address - Fax:808-245-7871
Practice Address - Street 1:4303 RICE ST
Practice Address - Street 2:C5
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-1359
Practice Address - Country:US
Practice Address - Phone:808-245-7871
Practice Address - Fax:808-245-7871
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3447174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI04031401Medicaid
HI0000BDJLLMedicare ID - Type Unspecified