Provider Demographics
NPI:1639356421
Name:BRENT DENLEY DO PA
Entity Type:Organization
Organization Name:BRENT DENLEY DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:DENLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:850-215-2344
Mailing Address - Street 1:215 E. 23RD STREET
Mailing Address - Street 2:SUITE C
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405
Mailing Address - Country:US
Mailing Address - Phone:850-215-2344
Mailing Address - Fax:850-215-2348
Practice Address - Street 1:221 E 23RD ST
Practice Address - Street 2:SUITE C
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-7612
Practice Address - Country:US
Practice Address - Phone:850-215-2344
Practice Address - Fax:850-215-2348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7753302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL47194OtherUPIN
FLHO1876Medicare UPIN
FL47194OtherUPIN