1710084330 NPI number — DR. MARTIN WILLIAM DENKER M.D.

Table of content: DR. MARTIN WILLIAM DENKER M.D. (NPI 1710084330)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710084330 NPI number — DR. MARTIN WILLIAM DENKER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DENKER
Provider First Name:
MARTIN
Provider Middle Name:
WILLIAM
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710084330
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2177 LOCKHART RD
Provider Second Line Business Mailing Address:
M. W. DENKER, M.D., P.A.
Provider Business Mailing Address City Name:
BROOKSVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34602-6208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-650-6978
Provider Business Mailing Address Fax Number:
352-583-5263

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12128 CORTEZ BLVD
Provider Second Line Business Practice Location Address:
WELLSPRING COUNSELING CENTER
Provider Business Practice Location Address City Name:
BROOKSVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34613-5575
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-592-7740
Provider Business Practice Location Address Fax Number:
352-592-7742
Provider Enumeration Date:
09/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  ME0019434 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 29683 . This is a "BC/BS PROVIDER NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 039766100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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