Provider Demographics
NPI:1992744452
Name:EVANS, SAMUEL J (MD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:J
Last Name:EVANS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1585 KAPIOLANI BLVD
Mailing Address - Street 2:SUITE 1800
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4522
Mailing Address - Country:US
Mailing Address - Phone:808-941-3363
Mailing Address - Fax:808-949-0483
Practice Address - Street 1:2230 LILIHA ST
Practice Address - Street 2:CRITICAL CARE DEPT.
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-1646
Practice Address - Country:US
Practice Address - Phone:808-342-6222
Practice Address - Fax:808-949-0483
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2016-02-26
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Provider Licenses
StateLicense IDTaxonomies
HIMD10768207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI50506805Medicaid
HI50506807Medicaid
HI50506806Medicaid
HI50506805Medicaid
HI50506807Medicaid