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General NPI Number Information
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NPI Number | 1639356421
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Entity Type | Organization
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Legal Business Name | BRENT DENLEY DO PA
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Dates
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Enumeration Date | 01/24/2008
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Last Update Date | 01/24/2008
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Provider Practice Location Address
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Address Line | 221 E 23RD ST SUITE C
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City | PANAMA CITY
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State | FL
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Zip | 32405-7612
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Country | US
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Telephone | 850-215-2344
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Fax | 850-215-2348
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Provider Business Mailing Address
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Address Line | 215 E. 23RD STREET SUITE C
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City | PANAMA CITY
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State | FL
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Zip | 32405
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Country | US
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Telephone | 850-215-2344
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Fax | 850-215-2348
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRENT JAMES DENLEY
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Credential | DO
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Telephone | 850-215-2344
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | OS7753
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License Number State | FL
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