Basic Information
| Provider Information | |||||||||
| NPI: | 1700176179 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | QUATTLEBAUM | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | HENRY NGUYEN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 677 ALA MOANA BLVD STE 1001 | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968135408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8084694900 | ||||||||
| FaxNumber: | 8085367315 | ||||||||
| Practice Location | |||||||||
| Address1: | 95-390 KUAHELANI AVE | ||||||||
| Address2: | |||||||||
| City: | MILILANI | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967891192 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8086273200 | ||||||||
| FaxNumber: | 8086237872 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2011 | ||||||||
| LastUpdateDate: | 02/13/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD2015-0527 | NM | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD-20848 | HI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.