Provider Demographics
NPI:1306917026
Name:HAMILTON-ALLER, LORA
Entity type:Individual
Prefix:
First Name:LORA
Middle Name:
Last Name:HAMILTON-ALLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75-5995 KUAKINI HWY
Mailing Address - Street 2:SUITE 213
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-2144
Mailing Address - Country:US
Mailing Address - Phone:808-329-1172
Mailing Address - Fax:
Practice Address - Street 1:75-5995 KUAKINI HWY
Practice Address - Street 2:SUITE 213
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-2144
Practice Address - Country:US
Practice Address - Phone:808-329-1172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD 8739208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH20448-0OtherHMSA
HI076757-05Medicaid
HI101242Medicare ID - Type UnspecifiedMEDICARE