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General NPI Number Information
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NPI Number | 1932552379
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Entity Type | Organization
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Legal Business Name | CRAIG J DENNY MD PROF
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Dates
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Enumeration Date | 07/21/2016
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Last Update Date | 09/28/2016
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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 |
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Provider Business Mailing Address
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Address Line | PO BOX 3354
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City | IDAHO FALLS
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State | ID
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Zip | 83403-3354
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Country | US
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Telephone | 208-525-2090
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Fax | 208-523-8978
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | JULI POPEJOY
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Credential |
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Telephone | 208-525-2090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | M-9188
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License Number State | ID
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