Provider Demographics
NPI:1942394390
Name:HENNINGER, DELMER WARD JR (MD)
Entity Type:Individual
Prefix:DR
First Name:DELMER
Middle Name:WARD
Last Name:HENNINGER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:39755 DATE ST
Mailing Address - Street 2:#101
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-2007
Mailing Address - Country:US
Mailing Address - Phone:951-698-6629
Mailing Address - Fax:951-698-8732
Practice Address - Street 1:39755 DATE ST
Practice Address - Street 2:#101
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-2007
Practice Address - Country:US
Practice Address - Phone:951-698-6629
Practice Address - Fax:951-698-8732
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2008-05-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA41831207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0082740Medicaid
CAA29473Medicare UPIN
CAGR0082740Medicaid