Provider Demographics
NPI:1831209717
Name:FODOR, RAYMOND I (MD)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:I
Last Name:FODOR
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 1:970 N KALAHEO AVE
Mailing Address - Street 2:SUITE A-323
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-1801
Mailing Address - Country:US
Mailing Address - Phone:808-254-3011
Mailing Address - Fax:808-254-4886
Practice Address - Street 1:970 N KALAHEO AVE
Practice Address - Street 2:SUITE A-323
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-1801
Practice Address - Country:US
Practice Address - Phone:808-254-3011
Practice Address - Fax:808-254-4886
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1910207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology