Provider Demographics
NPI:1457413239
Name:KOLLMORGEN, RODGER C (MD)
Entity Type:Individual
Prefix:DR
First Name:RODGER
Middle Name:C
Last Name:KOLLMORGEN
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 1:75-6081 ALII DR APT W204
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-4352
Mailing Address - Country:US
Mailing Address - Phone:808-322-4818
Mailing Address - Fax:808-322-4817
Practice Address - Street 1:79-1020 HAUKAPILA RAOD
Practice Address - Street 2:
Practice Address - City:KEALAKEKUA
Practice Address - State:HI
Practice Address - Zip Code:96750
Practice Address - Country:US
Practice Address - Phone:808-322-4818
Practice Address - Fax:808-322-4817
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD - 14272084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000569535Medicaid
HI0000254086OtherHMSA
HIA95339Medicare UPIN
HI100811Medicare ID - Type Unspecified