Provider Demographics
NPI:1053404624
Name:ENDICOTT, JOHN STERLING (MD, MPH)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:STERLING
Last Name:ENDICOTT
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:438 ULUNIU ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2517
Mailing Address - Country:US
Mailing Address - Phone:808-261-8842
Mailing Address - Fax:808-262-4822
Practice Address - Street 1:438 ULUNIU ST
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2517
Practice Address - Country:US
Practice Address - Phone:808-261-8842
Practice Address - Fax:808-262-4822
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-63542083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIL3451-6Medicare UPIN