Provider Demographics
NPI:1932188752
Name:THIBAULT, GREGORY P (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:P
Last Name:THIBAULT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3288 MOANALUA RD
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-1469
Mailing Address - Country:US
Mailing Address - Phone:808-432-8237
Mailing Address - Fax:808-432-8241
Practice Address - Street 1:3288 MOANALUA RD
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-1469
Practice Address - Country:US
Practice Address - Phone:808-432-8237
Practice Address - Fax:808-432-8241
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2021-06-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
HIMD8730208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN