Provider Demographics
NPI:1457394066
Name:HEINTZ, PERRY G (MD)
Entity Type:Individual
Prefix:
First Name:PERRY
Middle Name:G
Last Name:HEINTZ
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 1:1188 BISHOP ST
Mailing Address - Street 2:SUITE 3111
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-3313
Mailing Address - Country:US
Mailing Address - Phone:808-532-0660
Mailing Address - Fax:808-532-0663
Practice Address - Street 1:1188 BISHOP ST
Practice Address - Street 2:SUITE 3111
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-3313
Practice Address - Country:US
Practice Address - Phone:808-532-0660
Practice Address - Fax:808-532-0663
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD45492084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000011957OtherHAWAII MEDICAL SVC ASSN
HI01140601Medicaid
H0000BDLVQOtherMEDICARE PTAN
HIC98785Medicare UPIN
HI0000011957OtherHAWAII MEDICAL SVC ASSN