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General NPI Number Information
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NPI Number | 1144560541
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Entity Type | Organization
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Legal Business Name | M W DENKER MD PA
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Dates
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Enumeration Date | 02/21/2013
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Last Update Date | 04/16/2013
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Provider Practice Location Address
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Address Line | 12128 CORTEZ BLVD
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City | BROOKSVILLE
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State | FL
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Zip | 34613-5575
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Country | US
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Telephone | 352-592-7740
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Fax | 352-592-7742
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Provider Business Mailing Address
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Address Line | 2177 LOCKHART RD
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City | BROOKSVILLE
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State | FL
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Zip | 34602-6208
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Country | US
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Telephone | 352-650-6978
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Fax | 352-583-5263
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Authorized Official
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Title or Position | OWNER AND PRESIDENT
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Name | DR. MARTIN W DENKER
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Credential | M.D.
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Telephone | 352-650-6978
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | ME19434
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License Number State | FL
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