Healthcare Provider Details

I. General information

NPI: 1356565774
Provider Name (Legal Business Name): ALAN DAVID THAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55-3327 AKONI PULE HIGHWAY
HAWI HI
96719
US

IV. Provider business mailing address

PO BOX 879
KAPAAU HI
96755-0879
US

V. Phone/Fax

Practice location:
  • Phone: 808-889-5556
  • Fax: 808-889-5411
Mailing address:
  • Phone: 808-889-5556
  • Fax: 808-889-5411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD5213
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: