Provider Demographics
NPI:1932250479
Name:DAVID FITZ-PATRICK, MD INC.
Entity Type:Organization
Organization Name:DAVID FITZ-PATRICK, MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:J
Authorized Official - Last Name:FITZ-PATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-440-4413
Mailing Address - Street 1:1585 KAPIOLANI BLVD
Mailing Address - Street 2:SUITE 1500
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4522
Mailing Address - Country:US
Mailing Address - Phone:808-531-6886
Mailing Address - Fax:
Practice Address - Street 1:1585 KAPIOLANI BLVD
Practice Address - Street 2:SUITE 1500
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4522
Practice Address - Country:US
Practice Address - Phone:808-531-6886
Practice Address - Fax:808-523-5115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD4149174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI04789303Medicaid
HI04789303Medicaid
HIH55036Medicare PIN