Provider Demographics
NPI:1427060763
Name:EBISU, ROY J (MD)
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:J
Last Name:EBISU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:98-1079 MOANALUA RD
Mailing Address - Street 2:# 420
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-4789
Mailing Address - Country:US
Mailing Address - Phone:808-488-7770
Mailing Address - Fax:808-487-0104
Practice Address - Street 1:98-1079 MOANALUA RD
Practice Address - Street 2:# 420
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4789
Practice Address - Country:US
Practice Address - Phone:808-488-7770
Practice Address - Fax:808-487-0104
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2009-11-16
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Provider Licenses
StateLicense IDTaxonomies
HI3677207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI047827-01Medicaid
HI047827-01Medicaid
C98422Medicare UPIN