Provider Demographics
NPI:1043581655
Name:PAUL DENKER PA MD FACE
Entity Type:Organization
Organization Name:PAUL DENKER PA MD FACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:DENKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-441-4581
Mailing Address - Street 1:417 CORBETT STREET
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756
Mailing Address - Country:US
Mailing Address - Phone:727-441-4581
Mailing Address - Fax:727-447-4003
Practice Address - Street 1:417 CORBETT STREET
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756
Practice Address - Country:US
Practice Address - Phone:727-441-4581
Practice Address - Fax:727-447-4003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL43347261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041725400Medicaid
FL041725400Medicaid