Provider Demographics
NPI:1801076278
Name:STEPHEN DENIGRIS MD PHD
Entity type:Organization
Organization Name:STEPHEN DENIGRIS MD PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:DENIGRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-766-9852
Mailing Address - Street 1:PO BOX 27385
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94127-0385
Mailing Address - Country:US
Mailing Address - Phone:415-668-9371
Mailing Address - Fax:415-668-9191
Practice Address - Street 1:1383 N MCDOWELL BLVD
Practice Address - Street 2:STE 110
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-1187
Practice Address - Country:US
Practice Address - Phone:707-766-9852
Practice Address - Fax:707-766-1749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG87469207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty