Provider Demographics
NPI:1124056635
Name:TANABE, EUGENE T (MD)
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:T
Last Name:TANABE
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 1:98-1079 MOANALUA RD
Mailing Address - Street 2:#460
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-4713
Mailing Address - Country:US
Mailing Address - Phone:808-487-8922
Mailing Address - Fax:808-486-8466
Practice Address - Street 1:98-1079 MOANALUA RD
Practice Address - Street 2:#460
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4713
Practice Address - Country:US
Practice Address - Phone:808-487-8922
Practice Address - Fax:808-486-8466
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI4072208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00274901Medicaid
HIC98951Medicare UPIN
HIH0000BDHVTMedicare ID - Type Unspecified