Provider Demographics
NPI:1720270861
Name:DOUGLAS R. DAUTERMAN CO., INC
Entity Type:Organization
Organization Name:DOUGLAS R. DAUTERMAN CO., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:O
Authorized Official - Last Name:FLANIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-591-8860
Mailing Address - Street 1:250 WARD AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4007
Mailing Address - Country:US
Mailing Address - Phone:808-591-8860
Mailing Address - Fax:808-591-8869
Practice Address - Street 1:250 WARD AVE STE 100
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4007
Practice Address - Country:US
Practice Address - Phone:808-591-8860
Practice Address - Fax:808-591-8869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI56567401Medicaid
HI0386380001Medicare NSC