Provider Demographics
NPI:1821171372
Name:TONNER, DENISE R (MD)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:R
Last Name:TONNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 E CAUSEWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32963-2234
Mailing Address - Country:US
Mailing Address - Phone:772-360-4973
Mailing Address - Fax:
Practice Address - Street 1:908 E CAUSEWAY BLVD
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32963-2234
Practice Address - Country:US
Practice Address - Phone:772-360-4973
Practice Address - Fax:772-299-3005
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME64374207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373706300Medicaid
FLE08070Medicare UPIN