Healthcare Provider Details

I. General information

NPI: 1639158744
Provider Name (Legal Business Name): BEN ALBERT THOMPSON III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 02/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 MAHALANI ST
WAILUKU HI
96793-2526
US

IV. Provider business mailing address

221 MAHALANI ST
WAILUKU HI
96793-2526
US

V. Phone/Fax

Practice location:
  • Phone: 808-242-2256
  • Fax:
Mailing address:
  • Phone: 808-242-2256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number34475-020
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number17997
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number17997
License Number StateHI
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number17997
License Number StateHI
# 5
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number17997
License Number StateHI
# 6
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number100969
License Number StateAK
# 7
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number100969
License Number StateAK
# 8
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number100969
License Number StateAK
# 9
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number100969
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: