MEDICARE: RICHARD LANCE DEJOURNETT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	MD02562	HI

General Provider Information

NPI Number	:	1982691341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD LANCE DEJOURNETT M.D.

Provider Business Mailing Address
First Line	:	1380 LUSITANA ST
Second Line	:	SECOND FLOOR
City	:	HONOLULU
State	:	HI
Zip	:	96813-2449
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1380 LUSITANA ST
Second Line	:	SECOND FLOOR
City	:	HONOLULU
State	:	HI
Zip	:	96813-2449
Country	:	US
Telephone Number	:	808-599-4471
Fax Number	:	808-523-3849

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	11/02/2021

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