Healthcare Provider Details

I. General information

NPI: 1710915350
Provider Name (Legal Business Name): GARY M CABOT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 09/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2226 LILIHA ST SUITE 307
HONOLULU HI
96817-1600
US

IV. Provider business mailing address

PO BOX 10813
HONOLULU HI
96816-0813
US

V. Phone/Fax

Practice location:
  • Phone: 808-531-5823
  • Fax:
Mailing address:
  • Phone: 424-206-1919
  • Fax: 310-303-7944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD-4869
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberMD4869
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberMD4869
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: