Healthcare Provider Details

I. General information

NPI: 1134171614
Provider Name (Legal Business Name): KEVIN MARK DENNY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 JACKSON ST N
ST PETERSBURG FL
33705-1477
US

IV. Provider business mailing address

PO BOX 1830
CLEARWATER FL
33757-1830
US

V. Phone/Fax

Practice location:
  • Phone: 727-822-9497
  • Fax: 727-822-0330
Mailing address:
  • Phone: 727-532-0002
  • Fax: 727-532-1318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME48452
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: