Provider Demographics
NPI:1336174341
Name:PEKALA, RICHARD A (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:PEKALA
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 1:75-137 HUALALAI RD
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-1703
Mailing Address - Country:US
Mailing Address - Phone:808-329-1346
Mailing Address - Fax:808-329-1575
Practice Address - Street 1:75-137 HUALALAI RD
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-1703
Practice Address - Country:US
Practice Address - Phone:808-329-1346
Practice Address - Fax:808-329-1575
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-3984208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI04733201Medicaid
HI04733201Medicaid
HIH0000BDMZZMedicare PIN