Provider Demographics
NPI:1336179167
Name:IRVINE, ROBERT DAILEY (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DAILEY
Last Name:IRVINE
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 1:670 PONAHAWAI ST
Mailing Address - Street 2:SUITE 115
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2660
Mailing Address - Country:US
Mailing Address - Phone:808-935-5465
Mailing Address - Fax:808-935-5467
Practice Address - Street 1:670 PONAHAWAI ST
Practice Address - Street 2:SUITE 115
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2660
Practice Address - Country:US
Practice Address - Phone:808-935-5465
Practice Address - Fax:808-935-5467
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2284207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000036673OtherHAWAII MEDICAL SERVICES ASSOCIATION
HI03316401Medicaid
HI0000BDBXZMedicare ID - Type Unspecified
HI0000036673OtherHAWAII MEDICAL SERVICES ASSOCIATION