Provider Demographics
NPI:1104994201
Name:HALFORD, PETER (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:HALFORD
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 1:1329 LUSITANA
Mailing Address - Street 2:706
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813
Mailing Address - Country:US
Mailing Address - Phone:808-536-1107
Mailing Address - Fax:808-536-2931
Practice Address - Street 1:1329 LUSITANA
Practice Address - Street 2:706
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813
Practice Address - Country:US
Practice Address - Phone:808-536-1107
Practice Address - Fax:808-536-2931
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2135208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIMD2135OtherMDX 1991
HI00A0039105OtherHMSA 1991
HI03540801Medicaid
HI03540801Medicaid
C97419Medicare UPIN