Provider Demographics
NPI:1285640243
Name:WESTPHAL, DENIS ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:DENIS
Middle Name:ROBERT
Last Name:WESTPHAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 DECLARATION DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-4916
Mailing Address - Country:US
Mailing Address - Phone:530-345-9455
Mailing Address - Fax:530-345-6628
Practice Address - Street 1:95 DECLARATION DR
Practice Address - Street 2:SUITE 1
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-4916
Practice Address - Country:US
Practice Address - Phone:530-345-9455
Practice Address - Fax:530-345-6628
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50664208600000X, 2086S0102X, 2086S0127X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G506640Medicaid
A51767Medicare UPIN
CA00G506640Medicaid