Provider Demographics
NPI:1154403293
Name:SMITH, ROXANNE ALLISON (MD)
Entity type:Individual
Prefix:
First Name:ROXANNE
Middle Name:ALLISON
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ROXANNE
Other - Middle Name:SMITH
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1050 BISHOP ST STE 127
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-4210
Mailing Address - Country:US
Mailing Address - Phone:808-927-7793
Mailing Address - Fax:
Practice Address - Street 1:600 ALA MOANA BLVD APT 1902
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-4954
Practice Address - Country:US
Practice Address - Phone:808-927-7793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-21545207R00000X
DCMD034688207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD404367700Medicaid
DC035683200Medicaid
VA010093261Medicaid
013959H13Medicare PIN
MD404367700Medicaid