Provider Demographics
NPI:1285695940
Name:HURLBUT-MILLER, PETER RICHARD (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:RICHARD
Last Name:HURLBUT-MILLER
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 1:1620 ALA MOANA BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815-1437
Mailing Address - Country:US
Mailing Address - Phone:808-955-0255
Mailing Address - Fax:808-955-4155
Practice Address - Street 1:1620 ALA MOANA BLVD STE 500
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-1437
Practice Address - Country:US
Practice Address - Phone:808-955-0255
Practice Address - Fax:808-955-4155
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD21900207W00000X, 207WX0107X
UT7029008-1205207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX181972401Medicaid
TXP00331791OtherRAILROAD MEDICARE
I59991Medicare UPIN
TX8G7064Medicare PIN
TXI59991Medicare UPIN