Provider Demographics
NPI:1770569352
Name:HUSTEAD, THOMAS ROBERT (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:ROBERT
Last Name:HUSTEAD
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 1:1 JARRETT WHITE RD
Mailing Address - Street 2:DEPARTMENT OF FAMILY MEDICINE
Mailing Address - City:TRIPLER ARMY MEDICAL CENTER
Mailing Address - State:HI
Mailing Address - Zip Code:96859-5000
Mailing Address - Country:US
Mailing Address - Phone:808-433-3300
Mailing Address - Fax:808-433-1153
Practice Address - Street 1:2413 RING RD STE 100
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-5924
Practice Address - Country:US
Practice Address - Phone:270-737-0077
Practice Address - Fax:270-765-6243
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY50677207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine