Provider Demographics
NPI:1811096514
Name:RAITHAUS, LAWRENCE (MD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:
Last Name:RAITHAUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1329 LUSITANA ST
Mailing Address - Street 2:SUITE 602
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2429
Mailing Address - Country:US
Mailing Address - Phone:808-522-5055
Mailing Address - Fax:808-524-6306
Practice Address - Street 1:670 PONAHAWAI ST
Practice Address - Street 2:SUITE 118
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2660
Practice Address - Country:US
Practice Address - Phone:808-961-0151
Practice Address - Fax:808-961-5993
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HIMD-3306208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIMD-3306OtherSTATE LICENSE
HIMD-3306OtherSTATE LICENSE