Healthcare Provider Details

I. General information

NPI: 1629040118
Provider Name (Legal Business Name): WILLIAM DENNIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 04/14/2021
Certification Date: 04/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18701 N 67TH AVE
GLENDALE AZ
85308-7100
US

IV. Provider business mailing address

401 W PENNSYLVANIA AVE
ANACONDA MT
59711-1999
US

V. Phone/Fax

Practice location:
  • Phone: 623-561-1000
  • Fax:
Mailing address:
  • Phone: 406-563-8500
  • Fax: 406-563-8694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number61158
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number0101231448
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberMD115260
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: