Healthcare Provider Details

I. General information

NPI: 1356542609
Provider Name (Legal Business Name): MIRIAH BETH DENBO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MIRIAH BETH CHAPMAN M.D.

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 03/03/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 S. KINGS AVENUE, SUITE 3000
BRANDON FL
33511-6066
US

IV. Provider business mailing address

PO BOX 917770
ORLANDO FL
32891-0001
US

V. Phone/Fax

Practice location:
  • Phone: 813-681-6625
  • Fax: 813-684-6043
Mailing address:
  • Phone: 813-821-8038
  • Fax: 813-974-4325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME138771
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: