Provider Demographics
NPI:1336246693
Name:BLOEDON, WILLIAM EDWARD (DO)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:EDWARD
Last Name:BLOEDON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1279 S. KIHEI RD
Mailing Address - Street 2:SUITE # 120
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753
Mailing Address - Country:US
Mailing Address - Phone:808-891-6800
Mailing Address - Fax:808-891-6810
Practice Address - Street 1:1279 S KIHEI RD
Practice Address - Street 2:SUITE # 120
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-5222
Practice Address - Country:US
Practice Address - Phone:808-891-6800
Practice Address - Fax:808-891-6810
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HIDOS 698207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00J004597OtherHMSA
HI415568-05Medicaid
HI415568-05Medicaid
HIH50792Medicare PIN
HI00J004597OtherHMSA