Individual
DR. ROBERT RANDOLPH WATERFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
385 HUKILIKE ST, SUITE 210, KAHULUI, HI 96732-3522
(808) 871-8346
(808) 871-8344
Mailing address
PO BOX 923, WAILUKU, HI 96793-0923
(808) 268-5789
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
15055
HI
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
15055
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BW115Y
MEDICARE PTAN
HI
Enumeration date
07/31/2006
Last updated
02/15/2013
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