MEDICARE: BRENT DENLEY DO PA

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	302R00000X	Health Maintenance Organization	OS7753	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	47194	OTHER	FL	UPIN

General Provider Information

NPI Number	:	1639356421
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRENT DENLEY DO PA

Provider Business Mailing Address
First Line	:	215 E. 23RD STREET
Second Line	:	SUITE C
City	:	PANAMA CITY
State	:	FL
Zip	:	32405
Country	:	US
Telephone Number	:	850-215-2344
Fax Number	:	850-215-2348

Provider Business Practice Location Address
First Line	:	221 E 23RD ST
Second Line	:	SUITE C
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-7612
Country	:	US
Telephone Number	:	850-215-2344
Fax Number	:	850-215-2348

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BRENT JAMES DENLEY
Credential	:	DO
Telephone Number	:	850-215-2344

Provider Enumeration Date	:	01/24/2008
Last Update Date	:	01/24/2008

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Directions to “BRENT DENLEY DO PA ” Practice Location

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