Provider Demographics
NPI:1790801108
Name:TRALLER, DONALD W (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:W
Last Name:TRALLER
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:3639 ILIMA PL
Mailing Address - Street 2:
Mailing Address - City:KALAHEO
Mailing Address - State:HI
Mailing Address - Zip Code:96741-9153
Mailing Address - Country:US
Mailing Address - Phone:808-332-5862
Mailing Address - Fax:808-332-5862
Practice Address - Street 1:3-3420 KUHIO HWY STE B
Practice Address - Street 2:
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-1098
Practice Address - Country:US
Practice Address - Phone:808-256-1380
Practice Address - Fax:808-246-1381
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
HIADA69363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI53754001Medicaid
HI53754001Medicaid