Basic Information
| Provider Information | |||||||||
| NPI: | 1235100884 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ISSELL | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | MD FACP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 447 | ||||||||
| Address2: | |||||||||
| City: | HAUULA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967170447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082934129 | ||||||||
| FaxNumber: | 8082931425 | ||||||||
| Practice Location | |||||||||
| Address1: | 1301 PUNCHBOWL ST | ||||||||
| Address2: | QUEENS MEDICAL CENTER | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085389011 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | MD6397 | HI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 04951002 | 05 | HI | MEDICAID | C056329 | 01 | HI | HMSA BCBS | OTHER |