Healthcare Provider Details

I. General information

NPI: 1215915632
Provider Name (Legal Business Name): THOMAS EDWARD AUSTIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 03/06/2020
Certification Date: 03/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4141 QUEEN EMMAS DR
PRINCEVILLE HI
96722-5541
US

IV. Provider business mailing address

PO BOX 223764
PRINCEVILLE HI
96722-3764
US

V. Phone/Fax

Practice location:
  • Phone: 808-652-2262
  • Fax: 808-652-2262
Mailing address:
  • Phone: 808-652-2262
  • Fax: 888-373-9886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberG19445
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: