Provider Demographics
NPI:1467533893
Name:DENHAM, DOUGLAS S (DO)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:S
Last Name:DENHAM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 CRESTWAY
Mailing Address - Street 2:HEALTH CARE CENTER
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78233
Mailing Address - Country:US
Mailing Address - Phone:210-569-9800
Mailing Address - Fax:210-646-5606
Practice Address - Street 1:7400 CRESTWAY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78233
Practice Address - Country:US
Practice Address - Phone:210-569-9800
Practice Address - Fax:210-646-5606
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7995207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137961213Medicaid
TXE68564Medicare UPIN
TX84P520Medicare PIN