Provider Demographics
NPI:1992867030
Name:LAREAUX, ROBERT L (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:LAREAUX
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 MAHEALANI PL
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2530
Mailing Address - Country:US
Mailing Address - Phone:808-221-2774
Mailing Address - Fax:
Practice Address - Street 1:407 ULUNIU STREET
Practice Address - Street 2:SUITE 107
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2530
Practice Address - Country:US
Practice Address - Phone:808-266-0066
Practice Address - Fax:808-263-6004
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2017-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIP088213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI02487001Medicaid
HIBH706ZMedicare PIN
HIT41189Medicare UPIN