Provider Demographics
NPI:1023167947
Name:PARKER, RUSSELL ALAN (DO)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:ALAN
Last Name:PARKER
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Gender:M
Credentials:DO
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Mailing Address - Street 1:64-1032 MAMALAHOA HWY
Mailing Address - Street 2:STE 306
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-8441
Mailing Address - Country:US
Mailing Address - Phone:719-237-0590
Mailing Address - Fax:808-829-3604
Practice Address - Street 1:64-1032 MAMALAHOA HWY STE 306
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-8441
Practice Address - Country:US
Practice Address - Phone:719-237-0590
Practice Address - Fax:808-829-3604
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
HIDOS685208VP0000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine