Basic Information
| Provider Information | |||||||||
| NPI: | 1215958079 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTIN | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | LEWIS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | SR. | ||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MARTIN | ||||||||
| OtherFirstName: | ROBERT | ||||||||
| OtherMiddleName: | LEWIS | ||||||||
| OtherNamePrefix: | MR. | ||||||||
| OtherNameSuffix: | I | ||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 67-1268 KAMALOO ST | ||||||||
| Address2: | UNIT 7 | ||||||||
| City: | KAMUELA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967438389 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8087542154 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 65-1267 KAWAIHAE RD | ||||||||
| Address2: | WAIANAE COAST COMPREHENSIVE HEALTH CENTER | ||||||||
| City: | KAMUELA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967437345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8086967081 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2006 | ||||||||
| LastUpdateDate: | 10/24/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 9072 | HI | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.