Provider Demographics
NPI:1265645220
Name:DENEAU, TIMOTHY MELVIN (DO)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:MELVIN
Last Name:DENEAU
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:7979 E PRINCESS DR UNIT 2
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-5878
Mailing Address - Country:US
Mailing Address - Phone:480-256-0703
Mailing Address - Fax:502-301-5506
Practice Address - Street 1:101S. 5TH ST; 11TH FLOOR - NATIONAL CITY TOWER
Practice Address - Street 2:C/O HUMANA, INC
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202
Practice Address - Country:US
Practice Address - Phone:480-256-0703
Practice Address - Fax:502-301-5506
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2018-08-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NV562207Q00000X
AZ3429207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2019496Medicaid
NV2019496Medicaid