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Individual

TIMOTHY OLDFATHER

Active
Sole proprietor

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
82 PUUHONU PL, SUITE 202, HILO, HI 96720-2010
(808) 933-3040
(808) 933-3075
Mailing address
82 PUUHONU PL, SUITE 202, HILO, HI 96720-2010
(808) 933-3040
(808) 933-3075

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MD3343
HI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
03925801
HI
01
C43079
HMSA PROVIDER NUMBER
HI
Enumeration date
07/19/2005
Last updated
07/09/2007
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