Provider Demographics
NPI:1871637264
Name:DENISON, DANIEL D (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:D
Last Name:DENISON
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 1:2111 14TH ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-4041
Mailing Address - Country:US
Mailing Address - Phone:601-693-3834
Mailing Address - Fax:601-484-3225
Practice Address - Street 1:2111 14TH ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4041
Practice Address - Country:US
Practice Address - Phone:601-693-3834
Practice Address - Fax:601-484-3225
Is Sole Proprietor?:No
Enumeration Date:2007-02-18
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS21239208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07602854Medicaid
MS302I021836Medicare PIN