Provider Demographics
NPI:1821340852
Name:DENTON INTERNIST
Entity Type:Organization
Organization Name:DENTON INTERNIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RAZA
Authorized Official - Middle Name:A
Authorized Official - Last Name:JAFRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-591-8800
Mailing Address - Street 1:PO BOX 52159
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76206-2159
Mailing Address - Country:US
Mailing Address - Phone:940-591-8800
Mailing Address - Fax:940-591-0700
Practice Address - Street 1:2220 SAN JACINTO BLVD
Practice Address - Street 2:SUITE 310
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76205-7589
Practice Address - Country:US
Practice Address - Phone:940-591-8800
Practice Address - Fax:940-591-0700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-15
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty