Provider Demographics
NPI:1144560541
Name:M W DENKER MD PA
Entity type:Organization
Organization Name:M W DENKER MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:W
Authorized Official - Last Name:DENKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-650-6978
Mailing Address - Street 1:2177 LOCKHART RD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34602-6208
Mailing Address - Country:US
Mailing Address - Phone:352-650-6978
Mailing Address - Fax:352-583-5263
Practice Address - Street 1:12128 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-5575
Practice Address - Country:US
Practice Address - Phone:352-592-7740
Practice Address - Fax:352-592-7742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-21
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME19434261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL039766100Medicaid
FL29683OtherBC/BS PROVIDER NUMBER
FL039766100Medicaid
FLD53670Medicare UPIN