Provider Demographics
NPI:1699827071
Name:JON BETWEE M D LTD
Entity type:Organization
Organization Name:JON BETWEE M D LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:BETWEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-244-1003
Mailing Address - Street 1:270 WAIEHU BEACH RD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-1472
Mailing Address - Country:US
Mailing Address - Phone:808-244-1003
Mailing Address - Fax:808-244-3555
Practice Address - Street 1:270 WAIEHU BEACH RD
Practice Address - Street 2:SUITE 215
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1472
Practice Address - Country:US
Practice Address - Phone:808-244-1003
Practice Address - Fax:808-244-3555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI17902084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI03557303Medicaid
HIH0000BDQWTMedicare ID - Type UnspecifiedMEDICARE
HI03557303Medicaid