Provider Demographics
NPI:1235100884
Name:ISSELL, BRIAN F (MD FACP)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:F
Last Name:ISSELL
Suffix:
Gender:M
Credentials:MD FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 447
Mailing Address - Street 2:
Mailing Address - City:HAUULA
Mailing Address - State:HI
Mailing Address - Zip Code:96717-0447
Mailing Address - Country:US
Mailing Address - Phone:808-293-4129
Mailing Address - Fax:808-293-1425
Practice Address - Street 1:1301 PUNCHBOWL ST
Practice Address - Street 2:QUEENS MEDICAL CENTER
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813
Practice Address - Country:US
Practice Address - Phone:808-538-9011
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD6397207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI04951002Medicaid
HIC056329OtherHMSA BCBS
HIC056329OtherHMSA BCBS
H55178Medicare ID - Type Unspecified