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General NPI Number Information
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NPI Number | 1770728040
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Entity Type | Organization
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Legal Business Name | CRAIG J DENNY MD PROF CORP
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Dates
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Enumeration Date | 12/15/2008
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Last Update Date | 12/15/2008
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Provider Practice Location Address
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Address Line | 2280 E 25TH ST
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7542
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Country | US
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Telephone | 208-227-2100
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Fax | 208-227-2362
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Provider Business Mailing Address
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Address Line | 13975 S 1ST E
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7853
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Country | US
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Telephone | 208-357-7774
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Fax | 208-357-7778
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. ELLIE ROCK
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Credential |
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Telephone | 208-357-7774
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | M-9188
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License Number State | ID
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