Basic Information
| Provider Information | |||||||||
| NPI: | 1578702007 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LAWRENCE DERBES MD INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | ISLAND HEART AND VASCULAR | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 64-1032 MAMALAHOA HWY | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | KAMUELA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967438441 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083335303 | ||||||||
| FaxNumber: | 8083397425 | ||||||||
| Practice Location | |||||||||
| Address1: | 64-1032 MAMALAHOA HWY | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | KAMUELA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967438441 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083335303 | ||||||||
| FaxNumber: | 8083397425 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2009 | ||||||||
| LastUpdateDate: | 08/08/2013 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | DERBES | ||||||||
| AuthorizedOfficialFirstName: | LAWRENCE | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8089541327 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0011X | MD12544 | HI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
No ID Information.