Provider Demographics
NPI:1801877394
Name:CRABTREE, THOMAS GORDON (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:GORDON
Last Name:CRABTREE
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:970 N KALAHEO AVE
Mailing Address - Street 2:SUITE C-108
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-1866
Mailing Address - Country:US
Mailing Address - Phone:808-226-9220
Mailing Address - Fax:808-218-7891
Practice Address - Street 1:970 N KALAHEO AVE
Practice Address - Street 2:SUITE C-108
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-1866
Practice Address - Country:US
Practice Address - Phone:808-226-9220
Practice Address - Fax:808-218-7891
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HIMD-10310208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00B0284394OtherHMSA
HIH106563Medicare UPIN
VAD000Medicare UPIN
HI636235-01Medicaid