Provider Demographics
NPI:1578641197
Name:GOARD, CRAIG P (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:P
Last Name:GOARD
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:PO BOX 551774
Mailing Address - Street 2:
Mailing Address - City:KAPAAU
Mailing Address - State:HI
Mailing Address - Zip Code:96755-1774
Mailing Address - Country:US
Mailing Address - Phone:808-889-5030
Mailing Address - Fax:
Practice Address - Street 1:53-532 IOLE RD.
Practice Address - Street 2:
Practice Address - City:KAPAAU
Practice Address - State:HI
Practice Address - Zip Code:96755-1774
Practice Address - Country:US
Practice Address - Phone:808-889-5030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-15487207RC0000X
CAG38821207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G388210Medicaid
A47611Medicare UPIN
00G388210Medicare ID - Type Unspecified