MEDICARE: DR. MARK ALAN DENNER D.O

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	0S006150	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	80542	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1134121395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK ALAN DENNER D.O

Provider Business Mailing Address
First Line	:	14690 SPRING HILL DR
Second Line	:	SUITE 101
City	:	SPRING HILL
State	:	FL
Zip	:	34609-8102
Country	:	US
Telephone Number	:	352-799-0046
Fax Number	:	352-799-0042

Provider Business Practice Location Address
First Line	:	10200 YALE AVE
Second Line	:
City	:	WEEKI WACHEE
State	:	FL
Zip	:	34613-8375
Country	:	US
Telephone Number	:	352-597-1960
Fax Number	:	352-597-9470

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	07/21/2022

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