Basic Information
| Provider Information | |||||||||
| NPI: | 1558344622 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAMLIN | ||||||||
| FirstName: | ELVIN | ||||||||
| MiddleName: | RAY | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 73 PUUHONU PL STE 108 | ||||||||
| Address2: | |||||||||
| City: | HILO | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967202060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8089342009 | ||||||||
| FaxNumber: | 8089342041 | ||||||||
| Practice Location | |||||||||
| Address1: | 670 PONAHAWAI ST STE 220 | ||||||||
| Address2: | |||||||||
| City: | HILO | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967202660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8089357747 | ||||||||
| FaxNumber: | 8089357752 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2005 | ||||||||
| LastUpdateDate: | 10/30/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 31163 | MO | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084N0400X | DOS-1100 | HI | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 595431-01 | 05 | HI | MEDICAID | 0000267005 | 01 | HI | BCBS HAWAII HMSA | OTHER |