Healthcare Provider Details

I. General information

NPI: 1770572919
Provider Name (Legal Business Name): THOMAS E HENRY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 09/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98-084 KAMEHAMEHA HWY SUITE 301B
AIEA HI
96701-5160
US

IV. Provider business mailing address

P.O. BOX 700309
KAPOLEI HI
96709-0309
US

V. Phone/Fax

Practice location:
  • Phone: 808-486-4900
  • Fax: 808-486-4901
Mailing address:
  • Phone: 808-203-7943
  • Fax: 808-693-8060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD8901
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: