Provider Demographics
NPI:1619080405
Name:DENTON, JANE (DPM)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:DENTON
Suffix:
Gender:F
Credentials:DPM
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 6014
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-0014
Mailing Address - Country:US
Mailing Address - Phone:415-491-1210
Mailing Address - Fax:415-491-4647
Practice Address - Street 1:900 HYDE ST
Practice Address - Street 2:CENTER FOR SPORTS MEDICINE
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-4806
Practice Address - Country:US
Practice Address - Phone:415-353-6400
Practice Address - Fax:415-491-4647
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2913213ES0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT11515Medicare UPIN
CA000E29130Medicare ID - Type UnspecifiedPODIATRIST