Provider Demographics
NPI:1487710695
Name:BANNER, RICHARD ORLAND (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ORLAND
Last Name:BANNER
Suffix:
Gender:M
Credentials:MD
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 23348
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96823-3348
Mailing Address - Country:US
Mailing Address - Phone:808-781-2023
Mailing Address - Fax:808-973-0726
Practice Address - Street 1:1357 KAPIOLANI BLVD
Practice Address - Street 2:SUITE 1250
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4549
Practice Address - Country:US
Practice Address - Phone:808-973-1650
Practice Address - Fax:808-973-0726
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD34972083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI990298651-96706-E020OtherTRICARE
HI038840-01OtherALOHACARE
HI038840-01Medicaid
HI9902986510-03OtherUNIVERSITY HEALTH ALLIANC
HIMD3497-01OtherMDX HAWAII
HI9902986510-03OtherUNIVERSITY HEALTH ALLIANC
HIC98371Medicare UPIN