Provider Demographics
NPI:1609140375
Name:SHAVER, THOMAS L (DO)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:L
Last Name:SHAVER
Suffix:
Gender:M
Credentials:DO
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 1442
Mailing Address - Street 2:543760 HANAULA APO RD.
Mailing Address - City:KAPAAU
Mailing Address - State:HI
Mailing Address - Zip Code:96755-1439
Mailing Address - Country:US
Mailing Address - Phone:808-884-5282
Mailing Address - Fax:
Practice Address - Street 1:543760 HANAULA APO RD.
Practice Address - Street 2:
Practice Address - City:KAPAAU
Practice Address - State:HI
Practice Address - Zip Code:96755-1439
Practice Address - Country:US
Practice Address - Phone:808-884-5282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-28
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDOS - 820204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM