Provider Demographics
NPI:1235185265
Name:PERCELL, DENIS E (DO)
Entity Type:Individual
Prefix:
First Name:DENIS
Middle Name:E
Last Name:PERCELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2580
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65801-2580
Mailing Address - Country:US
Mailing Address - Phone:417-829-4620
Mailing Address - Fax:417-829-4316
Practice Address - Street 1:120 HOSPITAL DR
Practice Address - Street 2:SUITE 225
Practice Address - City:LEBANON
Practice Address - State:MO
Practice Address - Zip Code:65536-9238
Practice Address - Country:US
Practice Address - Phone:417-533-6710
Practice Address - Fax:417-533-6719
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1J47207V00000X
WI51046-21207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1235185265Medicaid
F26005Medicare UPIN
MOPENDINGMedicare PIN
WI07028--PENDINGMedicare PIN
MO1235185265Medicaid