Individual
MR. SEAN M REILLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
75-170 HUALALAI RD, STE C-110, KAILUA KONA, HI 96740-1741
(808) 329-9211
Mailing address
75-170 HUALALAI RD, STE C-110, KAILUA KONA, HI 96740-1741
(808) 329-9211
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
AMD183
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AMD183
STATE LICENSE
HI
Enumeration date
07/04/2006
Last updated
07/08/2007
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