Provider Demographics
NPI:1376626283
Name:LIVAUDAIS, GERARD F (MD)
Entity Type:Individual
Prefix:
First Name:GERARD
Middle Name:F
Last Name:LIVAUDAIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 WALUA PL
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-7153
Mailing Address - Country:US
Mailing Address - Phone:808-875-9762
Mailing Address - Fax:
Practice Address - Street 1:39 W KAMEHAMEHA AVE
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-2263
Practice Address - Country:US
Practice Address - Phone:808-877-2424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-11696207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI500844-02Medicaid
HI0000232033OtherHMSA BILLING NUMBER
HI0000232033OtherHMSA BILLING NUMBER
HI500844-02Medicaid