Provider Demographics
NPI:1154367530
Name:FUTH, STEPHEN BARRY (PA)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:BARRY
Last Name:FUTH
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-1107 KAI OIO ST
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-6536
Mailing Address - Country:US
Mailing Address - Phone:252-671-2891
Mailing Address - Fax:
Practice Address - Street 1:770 KAPIOLANI BLVD STE 705
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813
Practice Address - Country:US
Practice Address - Phone:808-597-8791
Practice Address - Fax:808-597-8781
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102320363A00000X
HIAMD831363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCS53933Medicare UPIN
NC2746085CMedicare PIN
NC970015631Medicare PIN