Provider Demographics
NPI:1982229993
Name:REIDELBACH, JOHN JOSEPH II (PA-C)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:JOSEPH
Last Name:REIDELBACH
Suffix:II
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:683 WAIANAE AVE BLDG G 1ST FLOOR, STE A
Mailing Address - Street 2:
Mailing Address - City:SCHOFIELD BARRACKS
Mailing Address - State:HI
Mailing Address - Zip Code:96786
Mailing Address - Country:US
Mailing Address - Phone:808-433-8475
Mailing Address - Fax:
Practice Address - Street 1:683 WAIANAE AVE BLDG G 1ST FLOOR, STE A
Practice Address - Street 2:
Practice Address - City:SCHOFIELD BARRACKS
Practice Address - State:HI
Practice Address - Zip Code:96786
Practice Address - Country:US
Practice Address - Phone:808-433-8475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-15
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1171933207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine