Healthcare Provider Details

I. General information

NPI: 1942201546
Provider Name (Legal Business Name): JOHN DENKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JOHN THOMAS DENKER M.D.

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 10/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5622 SE 41ST AVE
PORTLAND OR
97202-7516
US

IV. Provider business mailing address

5622 SE 41ST AVE
PORTLAND OR
97202-7516
US

V. Phone/Fax

Practice location:
  • Phone: 503-774-6929
  • Fax: 503-774-6924
Mailing address:
  • Phone: 503-774-6929
  • Fax: 503-774-6924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberMD 12668
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberMD 12668
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: