Provider Demographics
NPI:1982691341
Name:DEJOURNETT, RICHARD LANCE (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:LANCE
Last Name:DEJOURNETT
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:1380 LUSITANA ST
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2449
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1380 LUSITANA ST
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2449
Practice Address - Country:US
Practice Address - Phone:808-599-4471
Practice Address - Fax:808-523-3849
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2021-11-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
HIMD025622085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIC98407Medicare UPIN