Healthcare Provider Details

I. General information

NPI: 1164658019
Provider Name (Legal Business Name): BENJAMIN STUART THOMAS MD, MSCI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2009
Last Update Date: 10/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 ALA MOANA BLVD TOWER 5, SUITE 300
HONOLULU HI
96813-4920
US

IV. Provider business mailing address

1670 MAKALOA ST STE 204-324
HONOLULU HI
96814-3232
US

V. Phone/Fax

Practice location:
  • Phone: 808-531-7111
  • Fax: 808-528-5507
Mailing address:
  • Phone: 808-531-7111
  • Fax: 808-528-5507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number2013015515
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberMD-18023
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number073163
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: