Provider Demographics
NPI:1790943132
Name:DENSON, WILLIAM NICK (MD)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:NICK
Last Name:DENSON
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 1:2001 S WOODRUFF AVE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-6374
Mailing Address - Country:US
Mailing Address - Phone:208-206-0527
Mailing Address - Fax:
Practice Address - Street 1:2001 S WOODRUFF AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-6374
Practice Address - Country:US
Practice Address - Phone:208-206-0527
Practice Address - Fax:208-535-0440
Is Sole Proprietor?:No
Enumeration Date:2008-05-31
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013026058207V00000X
IDM-12580207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR200335001Medicaid
MOP01246708OtherRR MCR
MO431560263OtherTRICARE
MO1790943132Medicaid
MOP01246708OtherRR MCR