Healthcare Provider Details

I. General information

NPI: 1609140375
Provider Name (Legal Business Name): THOMAS L SHAVER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2012
Last Update Date: 02/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

543760 HANAULA APO RD.
KAPAAU HI
96755-1439
US

IV. Provider business mailing address

PO BOX 1442 543760 HANAULA APO RD.
KAPAAU HI
96755-1439
US

V. Phone/Fax

Practice location:
  • Phone: 808-884-5282
  • Fax:
Mailing address:
  • Phone: 808-884-5282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberDOS - 820
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: