Provider Demographics
NPI:1386783975
Name:DIAMOND, PETER ELLIOTT (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:ELLIOTT
Last Name:DIAMOND
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 1:932 WARD AVE
Mailing Address - Street 2:SUITE 460
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-2131
Mailing Address - Country:US
Mailing Address - Phone:808-521-6564
Mailing Address - Fax:808-521-1173
Practice Address - Street 1:932 WARD AVE
Practice Address - Street 2:SUITE 460
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-2131
Practice Address - Country:US
Practice Address - Phone:808-521-6564
Practice Address - Fax:808-521-1173
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-3536207XX0005X, 207XX0801X, 209800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Not Answered207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Not Answered209800000XAllopathic & Osteopathic PhysiciansLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C97375Medicare UPIN