Provider Demographics
NPI:1356542609
Name:DENBO, MIRIAH BETH (MD)
Entity type:Individual
Prefix:DR
First Name:MIRIAH
Middle Name:BETH
Last Name:DENBO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MIRIAH
Other - Middle Name:BETH
Other - Last Name:CHAPMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 917770
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-0001
Mailing Address - Country:US
Mailing Address - Phone:813-821-8038
Mailing Address - Fax:813-974-4325
Practice Address - Street 1:515 S. KINGS AVENUE,
Practice Address - Street 2:SUITE 3000
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-6066
Practice Address - Country:US
Practice Address - Phone:813-681-6625
Practice Address - Fax:813-684-6043
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME138771207V00000X
MN63175207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLNNMQLOtherBLUE CROSS BLUE SHIELD
FL102501700Medicaid