Healthcare Provider Details

I. General information

NPI: 1134121395
Provider Name (Legal Business Name): MARK ALAN DENNER D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10200 YALE AVE
WEEKI WACHEE FL
34613-8375
US

IV. Provider business mailing address

14690 SPRING HILL DR SUITE 101
SPRING HILL FL
34609-8102
US

V. Phone/Fax

Practice location:
  • Phone: 352-597-1960
  • Fax: 352-597-9470
Mailing address:
  • Phone: 352-799-0046
  • Fax: 352-799-0042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0S006150
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: