Provider Demographics
NPI:1942201546
Name:DENKER, JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:DENKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:THOMAS
Other - Last Name:DENKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5622 SE 41ST AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-7516
Mailing Address - Country:US
Mailing Address - Phone:503-774-6929
Mailing Address - Fax:503-774-6924
Practice Address - Street 1:5622 SE 41ST AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-7516
Practice Address - Country:US
Practice Address - Phone:503-774-6929
Practice Address - Fax:503-774-6924
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD 12668207QA0505X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
930862374OtherTRICARE
OR228700Medicaid
ORR0000BHPRBMedicare ID - Type UnspecifiedOREGON NORDIAN MEDICARE
930862374OtherTRICARE
ORC91164Medicare UPIN