Basic Information
| Provider Information | |||||||||
| NPI: | 1437342060 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOTTORFF | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | JACOB | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BOTTORFF | ||||||||
| OtherFirstName: | JACK | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 407 ULUNIU ST STE 411 | ||||||||
| Address2: | #411 | ||||||||
| City: | KAILUA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967342544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082637203 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 407 ULUNIU ST STE 411 | ||||||||
| Address2: | #411 | ||||||||
| City: | KAILUA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967342544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082637203 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2007 | ||||||||
| LastUpdateDate: | 01/22/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | E-6686 | AR | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | MD-16745 | HI | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.