Provider Demographics
NPI:1295989408
Name:SMITH, SCOTT HAL (PA-C)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:HAL
Last Name:SMITH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:711 KAPIOLANI BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-5255
Mailing Address - Country:US
Mailing Address - Phone:808-941-3363
Mailing Address - Fax:808-949-0483
Practice Address - Street 1:84 N CHURCH ST STE 206
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793
Practice Address - Country:US
Practice Address - Phone:808-281-7477
Practice Address - Fax:808-646-7383
Is Sole Proprietor?:No
Enumeration Date:2008-11-14
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HIAMD-331363A00000X
AZ4221363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIAMD-331OtherLIC
HI631826OtherHMA
HI285536OtherHMSA