Individual
RANDALL CHARLES BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1329 LUSITANA ST, SUITE 602, HONOLULU, HI 96813-2429
(808) 522-5055
(808) 524-6306
Mailing address
1329 LUSITANA ST, SUITE 602, HONOLULU, HI 96813-2429
(808) 522-5055
(808) 524-6306
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
14192
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100171930A
—
IN
Enumeration date
02/23/2006
Last updated
06/28/2012
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