Provider Demographics
NPI:1134121395
Name:DENNER, MARK ALAN (DO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALAN
Last Name:DENNER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14690 SPRING HILL DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-8102
Mailing Address - Country:US
Mailing Address - Phone:352-799-0046
Mailing Address - Fax:352-799-0042
Practice Address - Street 1:10200 YALE AVE
Practice Address - Street 2:
Practice Address - City:WEEKI WACHEE
Practice Address - State:FL
Practice Address - Zip Code:34613-8375
Practice Address - Country:US
Practice Address - Phone:352-597-1960
Practice Address - Fax:352-597-9470
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0S006150207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL372756400Medicaid
FL80542OtherBCBS
FL80542TMedicare PIN
FLF03399Medicare UPIN
FL80542UMedicare PIN
FL372756400Medicaid
FL80542VMedicare PIN