Healthcare Provider Details

I. General information

NPI: 1417918798
Provider Name (Legal Business Name): RUSSELL CHARLES GILBERT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 05/27/2020
Certification Date: 05/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PUNCHBOWL STREET
HONOLULU HI
96813-2499
US

IV. Provider business mailing address

1301 PUNCHBOWL STREET
HONOLULU HI
96813-2499
US

V. Phone/Fax

Practice location:
  • Phone: 808-691-1000
  • Fax:
Mailing address:
  • Phone: 808-691-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD-10842
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD-10842
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: