Provider Demographics
NPI:1437244795
Name:TALBOT, GEORGE L JR (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:L
Last Name:TALBOT
Suffix:JR
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 1:1279 S KIHEI RD STE 120
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-5222
Mailing Address - Country:US
Mailing Address - Phone:808-891-6800
Mailing Address - Fax:
Practice Address - Street 1:1279 S KIHEI RD STE 120
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-5222
Practice Address - Country:US
Practice Address - Phone:808-891-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-8766208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI075338-02Medicaid
HI00A0202448OtherHMSA BILLING NUMBER
HIH50879Medicare PIN