Healthcare Provider Details

I. General information

NPI: 1194352013
Provider Name (Legal Business Name): JUSTIN DENNY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 836 BOX 33
FPO AE
09636-0001
US

IV. Provider business mailing address

PSC 836 BOX 2670
FPO AE
09636-9998
US

V. Phone/Fax

Practice location:
  • Phone: 98-971-9355
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number84459
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: