Provider Demographics
NPI:1184304115
Name:BURDMAN, ROBERT PETER
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:PETER
Last Name:BURDMAN
Suffix:
Gender:M
Credentials:
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 109
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96721-0109
Mailing Address - Country:US
Mailing Address - Phone:808-640-9939
Mailing Address - Fax:
Practice Address - Street 1:16-1412 KOLOA MAOLI RD 9
Practice Address - Street 2:
Practice Address - City:KURTISTOWN
Practice Address - State:HI
Practice Address - Zip Code:96760
Practice Address - Country:US
Practice Address - Phone:808-640-9939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIH00383116172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver